Spigelman classification

  Gastroscopy, Oncology

The Spigelman classification is a system used to assess the severity and stage of duodenal polyposis in patients with Familial Adenomatous Polyposis (FAP). This classification helps guide the management and surveillance strategies for patients with FAP who are at risk for duodenal cancer. The system evaluates five variables: the number of polyps, the size of the largest polyp, the histology of the polyps, the presence of dysplasia, and the architectural complexity of the polyps. Each variable is scored, and the total score determines the stage of the disease.

Spigelman Classification Criteria

  1. Number of Polyps:
    • 1-4: 1 point
    • 5-20: 2 points
    • 20: 3 points
  2. Size of Largest Polyp:
    • 1-4 mm: 1 point
    • 5-10 mm: 2 points
    • 10 mm: 3 points
  3. Histology:
    • Tubular: 1 point
    • Tubulovillous: 2 points
    • Villous: 3 points
  4. Dysplasia:
    • Mild: 1 point
    • Moderate: 2 points
    • Severe: 3 points
  5. Architectural Complexity:
    • Mild: 1 point
    • Moderate: 2 points
    • Severe: 3 points

Scoring and Staging

  • Stage 0: 0 points
    • Surveillance: Endoscopy every 5 years
  • Stage I: 1-4 points
    • Surveillance: Endoscopy every 3-5 years
  • Stage II: 5-6 points
    • Surveillance: Endoscopy every 2-3 years
  • Stage III: 7-8 points
    • Surveillance: Endoscopy every 1-2 years
  • Stage IV: 9-12 points
    • Surveillance: Endoscopy every 6-12 months

References:

Brosens et al. Prevention and management of duodenal polyps in familial adenomatous polyposis. Gut 2005;54:1034–1043. doi: 10.1136/gut.2004.053843

Campos FG, Sulbaran M, Safatle-Ribeiro AV, Martinez CA. Duodenal adenoma surveillance in patients with familial adenomatous polyposis. World J Gastrointest Endosc. 2015;7(10):950‐959. doi:10.4253/wjge.v7.i10.950

Endoscopic management of polyposis syndromes: European Society of Gastrointestinal Endoscopy (ESGE) guideline

Spigelman AD, Williams CB, Talbot IC, Domizio P, Phillips RK. “Upper gastrointestinal cancer in patients with familial adenomatous polyposis.” The Lancet. 1989;2(8666):783-785. DOI: 10.1016/S0140-6736(89)90956-4