Issues

The cover image is a photograph (courtesy of Elena M. Stoffel, M.D., M.P.H.) of a diminutive polyp (2 mm in diameter) identified during colonoscopic surveillance with chromoendoscopic enhancement in a patient with Lynch Syndrome. The polyp is the circular mound daubed with blue dye and located just below and to the left of center. During a typical chromoendoscopic examination, the colonoscope is advanced to the cecum, and upon withdrawal, the entire colorectal mucosa is sprayed with approximately 100 ml of a solution of 0.2% indigo carmine and simethicone (achieving a 20:1 ratio by volume). The mucosa is carefully examined for polyps or areas suspicious for neoplasia, which then may be biopsied for histopathologic characterization. Although dye-spraying may highlight mucosal irregularities that are less obvious with standard white-light endoscopic exams, the prevalence, character, and clinical implications of the small lesions detected during chromoendoscopy are a subject of considerable debate. See articles by Stoffel et al. (beginning on page 507) and Hawk and Guillem (beginning on page 495) for more information (also see Stoffel et al. in the November issue of Cancer Prevention Research, beginning on page 470).