Konishi et al (see page 818) have documented morphological findings in 4147 colorectal neoplasms detected colonoscopically in a consecutive series of 5025 average risk subjects. The importance of their report lies in the understated and sobering perspective it brings to the concept of de novo colorectal cancer. They used high resolution magnifying endoscopy to detect, remove, and classify all epithelial neoplasms. The neoplasms were grouped as mucosal lesions (3605), submucosal cancers (91), and advanced cancers (451), although the advanced cancers were not considered further. The mucosal lesions included 3353 adenomas and 252 intramucosal carcinomas. In the West, the latter would be classified as adenomas with high grade dysplasia1 and for the purposes of this study were grouped with the adenomas, and are subsequently referred to as such.

The neoplasms were also grouped into depressed and non-depressed, the latter including flat, slightly raised, and polypoid lesions. The rationale for this was the previous demonstration of …