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An early flat depressed lesion in the cecum progressing to an advanced cancer in 20 months

  • Adolfo Parra-Blanco
    Correspondence
    Reprint requests: Adolfo Parra-Blanco, MD, PhD, Endoscopy Unit (10a Planta), Department of Gastroenterology, Hospital Universitario de Canarias, C/Ofra s/n,38320 La Laguna, Santa Cruz de Tenerife, Spain.
    Affiliations
    Department of Gastroenterology (A.P.-B., D.N.-P., A.Z.G.-G., N.H., E.Q.), Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain, Department of Radiology (K.I.F.), Dokkyo University School of Medicine, Tochigi, Japan
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  • David Nicolás-Pérez
    Affiliations
    Department of Gastroenterology (A.P.-B., D.N.-P., A.Z.G.-G., N.H., E.Q.), Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain, Department of Radiology (K.I.F.), Dokkyo University School of Medicine, Tochigi, Japan
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  • Antonio Z. Gimeno-García
    Affiliations
    Department of Gastroenterology (A.P.-B., D.N.-P., A.Z.G.-G., N.H., E.Q.), Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain, Department of Radiology (K.I.F.), Dokkyo University School of Medicine, Tochigi, Japan
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  • Kuang I. Fu
    Affiliations
    Department of Gastroenterology (A.P.-B., D.N.-P., A.Z.G.-G., N.H., E.Q.), Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain, Department of Radiology (K.I.F.), Dokkyo University School of Medicine, Tochigi, Japan
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  • Noemi Hernández
    Affiliations
    Department of Gastroenterology (A.P.-B., D.N.-P., A.Z.G.-G., N.H., E.Q.), Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain, Department of Radiology (K.I.F.), Dokkyo University School of Medicine, Tochigi, Japan
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  • Enrique Quintero
    Affiliations
    Department of Gastroenterology (A.P.-B., D.N.-P., A.Z.G.-G., N.H., E.Q.), Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain, Department of Radiology (K.I.F.), Dokkyo University School of Medicine, Tochigi, Japan
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Published:August 28, 2007DOI:https://doi.org/10.1016/j.gie.2007.01.028
      Colonoscopy is the gold standard for colorectal neoplasia detection, but adenomas and even advanced cancers can be missed.
      • Rex D.K.
      • Cutler D.S.
      • Lemmel G.T.
      • et al.
      Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies.
      • Haseman J.H.
      • Lemmel G.T.
      • Rahmani E.Y.
      • et al.
      Failure of colonoscopy to detect colorectal cancer: evaluation of 47 cases in 20 hospitals.
      Flat lesion detection is especially demanding, and missing such lesions could have important implications because they result in an increased risk for severe dysplasia or cancer.
      • Hayakawa M.
      • Shimokawa K.
      • Kusugami K.
      • et al.
      Clinicopathological features of superficial depressed-type colorectal neoplastic lesions.
      • Parra-Blanco A.
      • Gimeno-Garcia A.Z.
      • Nicolás-Pérez D.
      • et al.
      Risk for high-grade dysplasia or invasive carcinoma in colorectal flat adenomas in a Spanish population.
      Depressed lesions bear the highest malignancy potential. Although they only represent 0.6% to 3% of colorectal polyps in colonoscopy series, it is suspected that at least one fourth of advanced colorectal cancers are derived from depressed lesions.
      • Goto H.
      • Oda Y.
      • Murakami Y.
      • et al.
      Proportion of de novo cancers among colorectal cancers in Japan.
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