Nonpolypoid Colorectal Neoplasia

  • Seong Ho ParkEmail author


Since Muto et al. reported the first “small flat adenoma” of the colon in 1985 [1], the importance of nonpolypoid colorectal neoplasia is increasingly being recognized. In the past, all colorectal cancers were assumed to arise slowly from polypoid adenomas through the adenoma–carcinoma sequence in combination with the accumulation of genetic alterations and environmental changes. However, it is now widely accepted that a substantial proportion of colorectal cancers are attributed to nonpolypoid colorectal neoplasms.


Compute Tomography Colonography Narrow Band Imaging Polypoid Lesion Depressed Lesion Multidetector Compute Tomography Scanner 
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  1. 1.
    Muto T, Kamiya J, Sawada T, et al. Small “flat adenoma” of the large bowel with special reference to its clinicopathologic features. Dis Colon Rectum. 1985;28:847–851.CrossRefPubMedGoogle Scholar
  2. 2.
    Graser A, Stieber P, Nagel D, et al. Comparison of CT colonography, colonoscopy, sigmoidoscopy and faecal occult blood tests for the detection of advanced adenoma in an average risk population. Gut. 2009;58:241–248.CrossRefPubMedGoogle Scholar
  3. 3.
    Johnson CD, Chen MH, Toledano AY, et al. Accuracy of CT colonography for detection of large adenomas and cancers. N Engl J Med. 2008;359:1207–1217.CrossRefPubMedGoogle Scholar
  4. 4.
    Kim DH, Pickhardt PJ, Taylor AJ, et al. CT colonography versus colonoscopy for the detection of advanced neoplasia. N Engl J Med. 2007;357:1403–1412.CrossRefPubMedGoogle Scholar
  5. 5.
    Pickhardt PJ, Choi JR, Hwang I, et al. Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med. 2003;349:2191–2200.CrossRefPubMedGoogle Scholar
  6. 6.
    Regge D, Laudi C, Galatola G, et al. Diagnostic accuracy of computed tomographic colonography for the detection of advanced neoplasia in individuals at increased risk of colorectal cancer. JAMA. 2009;301:2453–2461.CrossRefPubMedGoogle Scholar
  7. 7.
    Levin B, Lieberman DA, McFarland B, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: A Joint Guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin. 2008;58:130–160.CrossRefPubMedGoogle Scholar
  8. 8.
    O’Brien MJ, Winawer SJ, Zauber AG, et al. Flat adenomas in the national polyp study: is there increased risk for high-grade dysplasia initially or during surveillance? Clin Gastroenterol Hepatol. 2004;2:905–911.CrossRefPubMedGoogle Scholar
  9. 9.
    Hurlstone DP, Cross SS, Adam I, et al. A prospective clinicopathological and endoscopic evaluation of flat and depressed colorectal lesions in the United Kingdom. Am J Gastroenterol. 2003;98:2543–2549.CrossRefPubMedGoogle Scholar
  10. 10.
    Park DH, Kim HS, Kim WH, et al. Clinicopathologic characteristics and malignant potential of colorectal flat neoplasia compared with that of polypoid neoplasia. Dis Colon Rectum. 2008;51:43–49; discussion 49CrossRefPubMedGoogle Scholar
  11. 11.
    Rembacken BJ, Fujii T, Cairns A, et al. Flat and depressed colonic neoplasms: a prospective study of 1000 colonoscopies in the UK. Lancet. 2000;355:1211–1214.CrossRefPubMedGoogle Scholar
  12. 12.
    Saitoh Y, Waxman I, West AB, et al. Prevalence and distinctive biologic features of flat colorectal adenomas in a North American population. Gastroenterology. 2001;120:1657–1665.CrossRefPubMedGoogle Scholar
  13. 13.
    Soetikno RM, Kaltenbach T, Rouse RV, et al. Prevalence of nonpolypoid (flat and depressed) colorectal neoplasms in asymptomatic and symptomatic adults. JAMA. 2008;299:1027–1035.CrossRefPubMedGoogle Scholar
  14. 14.
    Participants in the Paris Workshop. The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon: November 30 to December 1, 2002. Gastrointest Endosc. 2003;58:S3–S43.CrossRefGoogle Scholar
  15. 15.
    Kudo S. Endoscopic mucosal resection of flat and depressed types of early colorectal cancer. Endoscopy. 1993;25:455–461.CrossRefPubMedGoogle Scholar
  16. 16.
    Hurlstone DP, Sanders DS, Cross SS, et al. Colonoscopic resection of lateral spreading tumours: a prospective analysis of endoscopic mucosal resection. Gut. 2004;53:1334–1339.CrossRefPubMedGoogle Scholar
  17. 17.
    Tanaka S, Haruma K, Oka S, et al. Clinicopathologic features and endoscopic treatment of superficially spreading colorectal neoplasms larger than 20 mm. Gastrointest Endosc. 2001;54:62–66.CrossRefPubMedGoogle Scholar
  18. 18.
    Chiu HM, Lin JT, Chen CC, et al. Prevalence and characteristics of nonpolypoid colorectal neoplasm in an asymptomatic and average-risk Chinese population. Clin Gastroenterol Hepatol. 2009;7:463–470.CrossRefPubMedGoogle Scholar
  19. 19.
    Tsuda S, Veress B, Toth E, et al. Flat and depressed colorectal tumours in a southern Swedish population: a prospective chromoendoscopic and histopathological study. Gut. 2002;51:550–555.CrossRefPubMedGoogle Scholar
  20. 20.
    Soetikno R, Friedland S, Kaltenbach T, et al. Nonpolypoid (flat and depressed) colorectal neoplasms. Gastroenterology. 2006;130:566–576.CrossRefPubMedGoogle Scholar
  21. 21.
    Dekker E, Fockens P. New imaging techniques at colonoscopy: tissue spectroscopy and narrow band imaging. Gastrointest Endosc Clin N Am. 2005;15:703–714.CrossRefPubMedGoogle Scholar
  22. 22.
    Larghi A, Lecca PG, Costamagna G. High-resolution narrow band imaging endoscopy. Gut. 2008;57:976–986.CrossRefPubMedGoogle Scholar
  23. 23.
    Paggi S, Radaelli F, Amato A, et al. The impact of narrow band imaging in screening colonoscopy: a randomized controlled trial. Clin Gastroenterol Hepatol. 2009;7:1049–1054.CrossRefPubMedGoogle Scholar
  24. 24.
    Song LM, Adler DG, Conway JD, et al. Narrow band imaging and multiband imaging. Gastrointest Endosc. 2008;67:581–589.CrossRefPubMedGoogle Scholar
  25. 25.
    Fidler JL, Johnson CD, MacCarty RL, et al. Detection of flat lesions in the colon with CT colonography. Abdom Imaging. 2002;27:292–300.PubMedGoogle Scholar
  26. 26.
    Park SH, Ha HK, Kim AY, et al. Flat polyps of the colon: detection with 16-MDCT colonography – preliminary results. Am J Roentgenol. 2006;186:1611–1617.CrossRefGoogle Scholar
  27. 27.
    Park SH, Kim SY, Lee SS, et al. Sensitivity of CT colonography for nonpolypoid colorectal lesions interpreted by human readers and with computer-aided detection. Am J Roentgenol. 2009;193:70–78.CrossRefGoogle Scholar
  28. 28.
    Park SH, Lee SS, Choi EK, et al. Flat colorectal neoplasms: definition, importance, and visualization on CT colonography. Am J Roentgenol. 2007;188:953–959.CrossRefGoogle Scholar
  29. 29.
    Gluecker TM, Fletcher JG, Welch TJ, et al. Characterization of lesions missed on interpretation of CT colonography using a 2D search method. Am J Roentgenol.2004;182:881–889.Google Scholar
  30. 30.
    Park SH, Ha HK, Kim MJ, et al. False-negative results at multi-detector row CT colonography: multivariate analysis of causes for missed lesions. Radiology. 2005;235:495–502.CrossRefPubMedGoogle Scholar
  31. 31.
    Pickhardt PJ, Nugent PA, Choi JR, et al. Flat colorectal lesions in asymptomatic adults: implications for screening with CT virtual colonoscopy. Am J Roentgenol. 2004;183:1343–1347.Google Scholar
  32. 32.
    Thomeer M, Carbone I, Bosmans H, et al. Stool tagging applied in thin-slice multidetector computed tomography colonography. J Comput Assist Tomogr. 2003;27:132–139.CrossRefPubMedGoogle Scholar
  33. 33.
    Bertoni G, Sassatelli R, Conigliaro R, et al. Visual “disappearing phenomenon” can reliably predict the nonadenomatous nature of rectal and rectosigmoid diminutive polyps at endoscopy. Gastrointest Endosc. 1994;40:588–591.CrossRefPubMedGoogle Scholar
  34. 34.
    Fletcher JG, Booya F, Johnson CD, et al. CT colonography: unraveling the twists and turns. Curr Opin Gastroenterol. 2005;21:90–98.PubMedGoogle Scholar
  35. 35.
    Park SH, Yee J, Kim SH, et al. Fundamental elements for successful performance of CT colonography (virtual colonoscopy). Korean J Radiol. 2007;8:264–275.CrossRefPubMedGoogle Scholar
  36. 36.
    Iannaccone R, Laghi A, Catalano C, et al. Computed tomographic colonography without cathartic preparation for the detection of colorectal polyps. Gastroenterology. 2004;127:1300–1311.CrossRefPubMedGoogle Scholar
  37. 37.
    Fidler J, Johnson C. Flat polyps of the colon: accuracy of detection by CT colonography and histologic significance. Abdom Imaging. 2009; 34(2):157–171.CrossRefGoogle Scholar
  38. 38.
    Lostumbo A, Suzuki K, Dachman AH. Flat lesions in CT colonography. Abdom Imaging. 2009;doi:  10.1007/s00261-009-9562-3.

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of RadiologyUniversity of Ulsan College of Medicine, Asan Medical CenterSeoulKorea

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