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Screening for Nonpolypoid Colorectal Neoplasms—Reply
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In Reply: In response to Dr Pickhardt and colleagues, in our flat lesion study we used standard terminology (the Japanese Society for Cancer of the Colon and Rectum1) that is used in other clinical studies. In a previous publication,2 Pickhardt et al used the same definition of flat lesion: "a shallow plaquelike broad-based lesion with a height of less than one half of its width." Although "flat" colorectal neoplasms may be slightly elevated compared with the normal mucosa, their detection during high-resolution colonoscopy relies on color change, absence of vascularity, wall defect, and friability.
In the World Health Organization classification for colorectal neoplasia,3 which we used in our study, the term carcinoma in situ is interchangeable with high-grade dysplasia. Although there may be a tendency to avoid the term carcinoma, this is irrelevant to the pathologic criteria or the implication of the diagnosis. After adjusting for lesion . . . [Full Text of this Article]
Roy M. Soetikno, MD
roy.soetikno@va.gov
Tonya Kaltenbach, MD;
Robert V. Rouse, MD
Veterans Affairs Palo Alto Health Care System
Palo Alto, California
RELATED ARTICLE
Prevalence of Nonpolypoid (Flat and Depressed) Colorectal Neoplasms in Asymptomatic and Symptomatic Adults
Roy M. Soetikno, Tonya Kaltenbach, Robert V. Rouse, Walter Park, Anamika Maheshwari, Tohru Sato, Suzanne Matsui, and Shai Friedland
JAMA. 2008;299(9):1027-1035.
ABSTRACT
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RELATED LETTER
Screening for Nonpolypoid Colorectal Neoplasms
Perry J. Pickhardt, Bernard Levin, and John H. Bond
JAMA. 2008;299(23):2743.
EXTRACT
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