The presence of synchronous polyps in the same patient could be handled in a variety of ways that could bias reported results. For example, in clinical practice, one might argue that the observation of even a single significant sized lesion on CTC will result in a colonoscopy follow-up examination. Hence, one could argue that, in order to decrease reading time and reader fatigue, a detailed search for synchronous lesion is unnecessary if a significant lesion has already been detected. However, CC may be incomplete in 2-10% of patients and since the actual miss-rate for CC is estimated at 6-12% for 10 mm lesions, we suggest that both clinical and research based CTC interpretation involve a complete evaluation of the entire colon. Alternately, synchronous lesions could artificially increase by-polyp sensitivity by increasing dwell-time in evaluating one segment of colon; if one spends more time evaluating a polyp candidate; there is a greater likelihood in detecting a second adjacent lesion when one is present). Because of these complex biases that could affect sensitivity, the number of patients with synchronous lesions, the lesion sizes and histologies in those patients should be specified.
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