Table 9.
Duodenal adenomatosis staging systema
| Polyps | 1 Point | 2 Points | 3 Points |
|---|---|---|---|
| Number | <4 | 5–20 | >20 |
| Size | 0–4 mm | 5–10 mm | >10 |
| Histology | Tubular | Tubulovillous | Villous |
| Dysplasia | Mild | Moderate | Severe |
| Spigelman stage | Total points | Frequency of surveillance |
|---|---|---|
| Recommended duodenal surveillance frequencyb | ||
| 0 | 0 | Every 4 years |
| I | ≤4 | Every 2–3 years |
| II | 5–6 | Every 1–3 years |
| III | 7–8 | Every 6–12 months |
| IV | 9–12 | Expert surveillance every 3- 6 months |
| Surgical evaluation | ||
| Complete mucosectomy or duodenectomy or Whipple procedure if duodenal papilla is involved | ||
a
Adapted from ref. (154).
b
Adapted with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Genetic/Familial High-Risk Assessment: Colorectal V.1.2014. 2014 National Comprehensive Cancer Network (24) The NCCN Guidelines and illustrations herein may not be reproduced in any form for any purpose without the express written permission of the NCCN. To view the most recent and complete version of the NCCN Guidelines, go online to NCCN.org. NATIONAL COMPREHENSIVE CANCER NETWORK, NCCN, NCCN GUIDELINES, and all other NCCN content are trademarks owned by the National Comprehensive Cancer Network.