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In Reply: Dr Pickhardt and Dr Ferrucci and colleagues point out that the study by Pickhardt et al¹ had results different from ours. Other large and very recent studies, however, have also found that CTC had low sensitivity compared with colonoscopy.^2-3 These studies used a methodology similar to ours, and had poor results despite having experienced radiologists. Thus, the suggestion in several letters that inexperience accounts for our poor results is speculative.

We disagree with Ferrucci et al that our polyp size target threshold was too small. The optimal end points for studies of CTC remain uncertain. About 1% of polyps in the 6 to 9 mm range are malignant and at least 2% have high-grade dysplasia.⁴ No evidence states that patients or their physicians will accept leaving polyps less than 1 cm or even less than 5 mm in place, or that CTC examinations where small polyps are seen . . . [Full Text of this Article]

Peter B. Cotton, MD
cottonp@musc.edu
Digestive Disease Center
Medical University of South Carolina
Charleston

Douglas Rex, MD
Department of Gastroenterology
Indiana University Hospital
Indianapolis

David J. Vining, MD
Department of Radiology

Benoit Pineau, MD
Department of Gastroenterology
Wake Forest University School of Medicine
Winston-Salem, NC

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