Spigelman et al developed a staging system for duodenal polyposis in a patient with familial adenomatous polyposis (FAP). This can help determine the severity of disease and to guide the manageent strategy. The authors are from St. Mark's Hospital in London.
Patient selection: duodenal polyposis in a patient with FAP
Parameters:
(1) number of polyps
(2) size of polyps in mm
(3) histologic pattern
(4) histologic grade
Parameter
Finding
Points
number of polyps
<= 4
1
5 to 20
2
>= 21
3
size of polyps
<= 4 mm
1
5 to 10 mm
2
>= 11 mm
3
histologic pattern
tubular
1
tubulovillous
2
villouw
3
histologic grade
low-grade
1
high-grade
3
total score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 4
• maximum score: 12
• The higher the score the more serious the disease.
Total Score
Stage
Degree of Disease
4
Stage I
mild
5 or 6
Stage II
moderate
7 or 8
Stage III
severe
9 to 12
Stage IV
severe
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