Spigelman stage IV duodenal polyposis does not precede most duodenal cancer cases in patients with familial adenomatous polyposis

Thiruvengadam, Sushrut S.; López, Rocío; O’Malley, Margaret; LaGuardia, Lisa; Church, James M.; Kalady, Matthew F.; Walsh, R. Matthew; Burke, Carol A.

doi:10.1016/j.gie.2018.07.033

Cited by 44 publications

(99 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The concern is that it may increase the pick-up of small lesions and may artificially “upstage” the duodenal disease but without reflecting a higher cancer risk, compared with white light endoscopy. Recent data suggest that it is polyp size and the presence of high-grade dysplasia that are the most important predictors of cancer risk, polyp multiplicity 224. It should be noted that the Spigelman classification system was developed and validated using white light endoscopy, without high definition.…”

Section: Familial Adenomatous Polyposismentioning

confidence: 99%

Guidelines for the management of hereditary colorectal cancer from the British Society of Gastroenterology (BSG)/Association of Coloproctology of Great Britain and Ireland (ACPGBI)/United Kingdom Cancer Genetics Group (UKCGG)

Monahan

Bradshaw²,

Dolwani

et al. 2019

Gut

312

375

View full text Add to dashboard Cite

Heritable factors account for approximately 35% of colorectal cancer (CRC) risk, and almost 30% of the population in the UK have a family history of CRC. The quantification of an individual’s lifetime risk of gastrointestinal cancer may incorporate clinical and molecular data, and depends on accurate phenotypic assessment and genetic diagnosis. In turn this may facilitate targeted risk-reducing interventions, including endoscopic surveillance, preventative surgery and chemoprophylaxis, which provide opportunities for cancer prevention. This guideline is an update from the 2010 British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland (BSG/ACPGBI) guidelines for colorectal screening and surveillance in moderate and high-risk groups; however, this guideline is concerned specifically with people who have increased lifetime risk of CRC due to hereditary factors, including those with Lynch syndrome, polyposis or a family history of CRC. On this occasion we invited the UK Cancer Genetics Group (UKCGG), a subgroup within the British Society of Genetic Medicine (BSGM), as a partner to BSG and ACPGBI in the multidisciplinary guideline development process. We also invited external review through the Delphi process by members of the public as well as the steering committees of the European Hereditary Tumour Group (EHTG) and the European Society of Gastrointestinal Endoscopy (ESGE). A systematic review of 10 189 publications was undertaken to develop 67 evidence and expert opinion-based recommendations for the management of hereditary CRC risk. Ten research recommendations are also prioritised to inform clinical management of people at hereditary CRC risk.

show abstract

Section: Familial Adenomatous Polyposismentioning

confidence: 99%

Guidelines for the management of hereditary colorectal cancer from the British Society of Gastroenterology (BSG)/Association of Coloproctology of Great Britain and Ireland (ACPGBI)/United Kingdom Cancer Genetics Group (UKCGG)

Monahan

Bradshaw²,

Dolwani

et al. 2019

Gut

312

375

View full text Add to dashboard Cite

show abstract

“…Furthermore, only 2 components of the Spigelman score, polyp size 10 mm and high-grade dysplasia (HGD), were associated with the development of duodenal cancer. As previously suggested by Sourrouille et al, 5 Thiruvengadam et al 4 concluded that the Spigelman scoring system in its current form is not optimal for risk stratification of patients at risk for duodenal cancer.…”

mentioning

confidence: 90%

“…Therefore, data are often limited, and guidelines are based on expert opinion. In a recent study, Thiruvengadam et al 4 took on the challenge of investigating a rare outcome, duodenal cancer, in a rare disease, FAP. They performed a case-control study to investigate the relationship between demographic, clinical, and endoscopic risk factors and duodenal cancer in patients with FAP.…”

mentioning

confidence: 99%

Challenges and pitfalls of investigating duodenal cancer in patients with familial adenomatous polyposis

Roos

Bastiaansen²,

Dekker³

2019

Gastrointestinal Endoscopy

View full text Add to dashboard Cite

show abstract

“…Reasons for this include biopsy sampling error and a paucity of macroscopic features of malignancy such as ulceration, firmness, friability and contact bleeding 9 15. Roughly half of patients who develop cancer do not have Spigelman stage IV disease 16. Lastly, the lack of distinction between ampullary and non-ampullary polyposis in the Spigelman classification underestimates the need for more intensive surveillance in patients with ampullary disease 4 12 17…”

Section: Introductionmentioning

confidence: 99%

Endoscopic ultrasound in the assessment of advanced duodenal adenomatosis in familial adenomatous polyposis

Labib

Goodchild

Turbett

et al. 2019

BMJ Open Gastroenterol

View full text Add to dashboard Cite

ObjectiveCurrent surveillance strategies for duodenal adenomatosis in familial adenomatous polyposis (FAP) miss malignancies and underestimate cancer risk in ampullary disease. This study aimed to evaluate the utility of endoscopic ultrasound (EUS) in the assessment of FAP patients with duodenal and/or ampullary polyposis referred for surgical intervention.DesignA retrospective analysis of FAP patients undergoing index EUS between December 2006 and May 2015 was performed. Follow-up was completed in January 2018, including review of all EUS procedures and surgical interventions (median follow-up 6 years).ResultsFifty-five patients underwent 188 EUS procedures. Six patients (11%) developed malignancy (three duodenal, three ampullary). Ampullary cancer risk was underestimated by Spigelman stage and overestimated by Kashiwagi classification. Ultrasound findings were poor predictors of malignancy, with common bile duct dilatation being the only finding present in one EUS prior to a diagnosis of ampullary cancer. The best predictors of ampullary malignancy were an ampullary polyp size >3 cm and an increase >1 cm in ampullary polyp size. Ampullary polyp size >3 cm provided the best predictive value, correctly identifying two of the three cases of ampullary cancer and both patients with high-grade dysplasia. EUS biopsy failed to detect malignancy later confirmed by surgical histology in two patients.ConclusionEUS surveillance confers little additional benefit to standard endoscopic surveillance in FAP patients. The best predictor of ampullary malignancy is an ampullary polyp >3 cm; this could be regarded as a relative indication for surgery.

show abstract

Spigelman stage IV duodenal polyposis does not precede most duodenal cancer cases in patients with familial adenomatous polyposis

Cited by 44 publications

References 23 publications

Guidelines for the management of hereditary colorectal cancer from the British Society of Gastroenterology (BSG)/Association of Coloproctology of Great Britain and Ireland (ACPGBI)/United Kingdom Cancer Genetics Group (UKCGG)

Guidelines for the management of hereditary colorectal cancer from the British Society of Gastroenterology (BSG)/Association of Coloproctology of Great Britain and Ireland (ACPGBI)/United Kingdom Cancer Genetics Group (UKCGG)

Challenges and pitfalls of investigating duodenal cancer in patients with familial adenomatous polyposis

Endoscopic ultrasound in the assessment of advanced duodenal adenomatosis in familial adenomatous polyposis

Contact Info

Product

Resources

About