Screening for prostate cancer--the controversy that refuses to die.
- Michael J Barry
- The New England journal of medicine
vs optical colonoscopy. Unfortunately, the study by Regge et al did not report actual pathologic sizes so it is difficult to determine the potential clinical effect of polyp size discrepancies. In the future, studies evaluating CT colonography should not only report about the presence or absence of neoplasia, but also include important information about size and morphology. Dr Matuchansky appropriately raises a concern about the potential failure of CT colonography in detecting flat lesions. As the indications for CT colonography are further refined, care must be taken to minimize the risks of missing these subtle lesions. Patient populations at increased risk for flat polyps need to be identified and potentially excluded from screening and surveillance CT colonography protocols. As Matuchansky points out, recent studies suggest that patients at high risk for colorectal cancer may have a greater risk of flat polyps, raising the question of whether CT colonography should be used in this population. The study by Regge et al, however, included only high-risk patients and reported high sensitivity for CT colonography in detecting advanced neoplasia in this population. Because information about the frequency of flat polyps was not reported in their study, it is difficult to determine the relative importance of high-risk status and flat polyps on the performance of CT colonography as a screening tool.