Flat (nonpolypoid) colorectal lesions identified at CT colonography in a U.S. screening population

The aim of this study was to investigate the clinical importance and height definition of flat (nonpolypoid) colorectal lesions detected on screening computed tomographic colonography (CTC).

Results from prospective screening CTC in 5107 consecutive asymptomatic adults (mean age, 56.9 years) at a single center were analyzed. All detected colorectal lesions > or = 6 mm were prospectively categorized as polypoid or flat (nonpolypoid). The maximal height of all flat lesions was measured to assess the suggested 3-mm threshold definition.

Of 954 polyps measuring > or = 6 mm identified on screening CTC, 125 lesions (13.1%) in 106 adults were prospectively categorized as flat, with a mean size of 12.7 mm (range, 6-80 mm), including 73 lesions 6 to 9 mm, 42 lesions 10 to 29 mm, and 10 lesions > or = 3 cm (carpet lesions). For polyps between 6 and 30 mm in size, flat lesions were less likely than polypoid lesions to be neoplastic (25.0% vs 60.3%, P < .001), histologically advanced (5.4% vs 12.1%, P = .07) or malignant (0% vs 0.5%, P = NS). Two of 10 carpet lesions (20%) were malignant, compared to 50% of polypoid masses > or = 3 cm. Of nine flat lesions seen only on colonoscopy (false-negatives on CTC), two were neoplastic (tubular adenomas), and none was histologically advanced. For all flat lesions between 6 and 30 mm, the maximal height averaged 2.2 mm and was < or =3 mm in 86.1%, including 93.2% of small 6-mm to 9-mm flat lesions.

In a US screening population, flat colorectal lesions detected on CTC demonstrated less aggressive histologic features compared to polypoid lesions. Excluding carpet lesions, a maximal height of 3 mm appears to be a reasonable definition.