Table 17.

Strengths and weaknesses of the Spigelman stage

Strengths	Weaknesses
Practical, replicable, and easy to compute (four variables only)	Suboptimal sensitivity: 50% of familial adenomatous polyposis develop duodenal cancers without stage IV polyposis Papillary cancer can occur at almost any stage
Can measure progression/regression over time	Equal weight to all four components (villous histology has a weaker association with cancer than other components)
	Developed with white-light endoscopy. Chromoendoscopy may increase the number of duodenal polyps.
	Fails to consider other risk factors for duodenal adenocarcinoma.
	Does not account for previous severity of polyposis