菜单
Applies the GAPP score to assess metastasis risk in PPGL based on histopathological features. Triggers include: 'PPGL tumor requiring histopathological risk assessment,' 'Evaluating tumor grade for metastatic potential,' 'Determining follow-up intensity based on histological scoring.'
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For a person with confirmed islet autoantibodies (early-stage type 1 diabetes), state the numerical progression risk to Stage 3 T1D by stage and age, set the age-stratified monitoring frequency (metabolic and HbA1c), apply the ≥10% longitudinal HbA1c rise → OGTT rule, and give the standard risk-modifier and communication framing. Use when a clinician asks how often should I monitor this Stage 1 child, what's the risk of this teenager progressing to insulin, adult with GAD positive what's the 5-year risk, my patient's HbA1c has risen 12% is that important, single autoantibody how often to retest, or how to counsel a family about progression risk. Grounded in Phillip et al. Diabetologia 2024 international staging and monitoring consensus, cross-referenced with Hussain et al 2026 IDF Europe roadmap.
Order and confirm islet autoantibody screening for early-stage type 1 diabetes — which antibodies to test (GAD65, IAA, IA2, ZnT8), sample types (capillary dried blood spot, venous), the mandatory two-sample two-method confirmation protocol, and how to interpret a positive, negative, or single-antibody result. Use when a clinician asks how to screen for early T1D, which islet autoantibodies to order, how to confirm a positive T1D antibody screen, is one autoantibody enough for T1D diagnosis, GAD antibody positive what next, or is running a general population or family-history T1D screening program. Grounded in Hussain et al 2026 (Diabetes, Obesity and Metabolism, IDF Europe consensus, DOI 10.1111/dom.70569).
Classify a person with a positive islet autoantibody screen into a specific stage of type 1 diabetes (At Risk / Stage 1 / Stage 2a / Stage 2b / Stage 3a / Stage 3b / Stage 4) using the international consensus staging framework based on autoantibody count and glycaemic status. Use when a clinician asks how to stage a positive autoantibody screen, what stage of T1D is this, is this early-stage T1D, does this child need insulin yet, is this presymptomatic T1D, does this qualify for teplizumab, or presents a person with any combination of islet autoantibodies + glucose data. Applies across paediatric and adult populations. Grounded in Hussain et al 2026 (Diabetes, Obesity and Metabolism, IDF Europe consensus, DOI 10.1111/dom.70569).
基于 SOC 职业分类
正在显示 SKILL.md
| name | ppgl-gapp-score-application |
| description | Applies the GAPP score to assess metastasis risk in PPGL based on histopathological features. Triggers include: 'PPGL tumor requiring histopathological risk assessment,' 'Evaluating tumor grade for metastatic potential,' 'Determining follow-up intensity based on histological scoring.' |
Obtain formalin-fixed paraffin-embedded tumor slides and pathology report; document presence of necrosis, vascular invasion, and mitotic count per 10 high-power fields (HPF).
If adequate tumor tissue is available for histopathological evaluation, proceed to scoring; otherwise, the GAPP score cannot be applied and alternative risk assessment methods should be considered.
Assign points: necrosis (0‑2), vascular invasion (0‑2), mitotic count (≥5/10 HPF = 1 point); sum to obtain GAPP score (0‑5). Stratify risk: low (0‑2), intermediate (3‑4), high (5).
For high GAPP score (≥5), recommend intensified surveillance (e.g., contrast-enhanced MRI or 18F‑FDG PET every 6 months) and consider genetic testing for SDHB; for low/intermediate scores, follow standard postoperative surveillance (annual biochemical testing and imaging every 1‑2 years).
Requires expert pathology assessment; avoid using GAPP score alone without clinical context; do not substitute for genetic testing; be aware of inter‑observer variability and sampling error in small biopsies.
A 48‑year‑old with an adrenal PPGL shows focal necrosis (1 point), focal vascular invasion (1 point), and mitotic count of 6/10 HPF (1 point) → GAPP score = 3 (intermediate risk) → schedule annual abdominal MRI and yearly plasma‑free metanephrines.
Source: Japan Endocrine Society Clinical Practice Guideline for the Diagnosis and Management of Pheochromocytoma and Paraganglioma 2025, Japan Endocrine Society, 2025, DOI:10.1507/endocrj.EJ25-0165
TODO: consider adding scripts/calc.py for the ppgl-gapp-score-application calculator