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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.

Given the lack of metastatic potential, it is widely accepted that "carcinoma in situ" should . . . [Full Text of this Article]

Perry J. Pickhardt, MD
pj.pickhardt@hosp.wisc.edu
Department of Radiology
University of Wisconsin Medical School
Madison

Bernard Levin, MD
Department of Gastroenterology
University of Texas M. D. Anderson Cancer Center
Houston

John H. Bond, MD
Department of Gastroenterology
Minneapolis VA Medical Center
Minneapolis, Minnesota

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