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June 18, 2008

Screening for Nonpolypoid Colorectal Neoplasms

JAMA. 2008;299(23):2743-2744. doi:10.1001/jama.299.23.2743-a

To the Editor: In their cross-sectional study, Dr Soetikno and colleagues1 reported that nonpolypoid colorectal neoplasms were relatively common in an older male veterans hospital population. We have several concerns regarding the study design and conclusions.

The terminology is unclear. A distinction must be made between the relatively flat lesions described in this study (defined as elevated lesions with a height less than half the diameter) and completely flat or depressed lesions. The authors note that “completely flat lesions are exceedingly rare” and were presumably absent in this study. Depressed lesions comprised less than 1% of all colorectal lesions (18/2770), only 4 of which were seen at screening. Therefore, nearly all nonpolypoid lesions were elevated from the surrounding mucosa, which is a critical distinction favoring detection at both standard colonoscopy and computed tomographic (CT) colonography.