![]() ![]() We recruited asymptomatic adults who were referred for colorectal cancer screening. The institutional review boards at all 3 participating medical centers approved the study protocol for same-day VC and OC, and all patients provided written informed consent. These data not only provide novel insight into OC miss rates but also indicate the relative “blind spots” where more attention could be focused. By using a reference standard other than OC itself for comparison, we could uncover lesions that may be systematically missed on repeated colonoscopies. In a large, prospective, multicenter trial that was primarily intended to evaluate the performance of virtual colonoscopy (VC) in asymptomatic adults (6), we also had a unique opportunity to evaluate the adenoma miss rate on OC by “segmentally unblinding” the results from same-day VC. ![]() However, in addition to evaluating relatively small populations of patients with a high prevalence of polyps, a notable weakness common to these studies was that they used OC as its own reference standard. More recently, prospective back-to-back or “tandem” colonoscopy studies have reported miss rates for 10-mm adenomas ranging from 0% to 6% (4, 5). Retrospective analysis has suggested that the OC miss rate for adenomas 10 mm or greater is approximately 10% (3). However, even in the most experienced hands, this skilled examination is understandably not infallible. Optical colonoscopy (OC) is widely accepted as the gold standard for detecting colorectal neoplasia (1, 2). Neither OC nor VC is a perfect test: Each misses 10% to 14% of adenomas that measure 6 mm or greater. ![]()
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