title: Attenuated adenomatous polyposis coli: the role of ascertainment bias through failure to dye-spray at colonoscopy.
abstract: OBJECTIVE
  The aim of this study is to show that the diagnosis of attenuated adenomatous polyposis coli must be made with caution and certainly only after adequate colonic examination with dye-spray.
  
  
  METHODS
  Four patients thought to have attenuated adenomatous polyposis coli on the basis of family history and the identification of fewer than 100 polyps on simple colonoscopy underwent colonoscopy with dye-spray.
  
  
  RESULTS
  All four individuals were found to have more than 100 polyps when dye-spray was used, confirming a diagnosis of classical familial adenomatous polyposis.
  
  
  CONCLUSIONS
  The diagnosis of familial adenomatous polyposis may be missed altogether or incorrectly assigned as attenuated adenomatous polyposis coli if dye-spray is not used at colonoscopy. Patients with a family history of familial adenomatous polyposis or colorectal cancer should be considered for dye-spray before the diagnosis of familial adenomatous polyposis is excluded or one of attenuated adenomatous polyposis coli is made.
authors.affiliation: ICRF Colorectal Cancer Unit and The Polyposis Registry, St Mark's Hospital, Harrow, United Kingdom.
authors.forename: M H
authors.initials: MH
authors.lastname: Wallace
authors.forename: I M
authors.initials: IM
authors.lastname: Frayling
authors.forename: S K
authors.initials: SK
authors.lastname: Clark
authors.forename: K
authors.initials: K
authors.lastname: Neale
authors.forename: R K
authors.initials: RK
authors.lastname: Phillips
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000175:diagnosis* / Q000473:pathology; D000328:Adult; D003113:Colonoscopy / Q000592:standards*; D004396:Coloring Agents; D003937:Diagnosis, Differential; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008297:Male; D012680:Sensitivity and Specificity
chemical_list: D004396:Coloring Agents