The Van Nuys Prognostic Index: offers a more tailored prognosis than the one size fits all treatment approach. It is based on size & grade of DCIS, margins and age of patient.
DCIS patients with scores of 4, 5 or 6 can be considered for treatment with excision only. Patients with scores (7, 8, or 9) should be considered for radiation therapy or be re-excised if cosmetically feasible. Patients with scores of 10, 11, or 12 should be considered for mastectomy.
| Table 1: The USC/VNPI scoring system. | ||||||||||||||||||||||||||||||||||||
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| Modified from Silverstein; Ductal Carcinoma in situ of the breast 2nd ed. 2002. | ||||||||||||||||||||||||||||||||||||
Dr. Michael Lagios, a world renowned DCIS expert and pathologist offers a consulting service, that anyone can use. In addition to reviewing your pathology, he will also use the Van Nuys Prognostic Index to calculate your personal risk of recurrence without radiation.
| USC/VNPI Score, Margin Width | Patients (N = 1673) | Treatment Needed | 12-Year Recurrence |
| All 4, 5, or 6 | 420 | Excision alone | ≤7% |
| 7, margins ≥3 mm | 196 | Excision alone | 16% |
| 7, margins < 3 mm | 117 | Excision plus radiation | 14% |
| 8, margins ≥3 mm | 128 | Excision plus radiation | 14% |
| 8, margins < 3 mm | 183 | Mastectomy | 0% |
| 9, margins ≥5 mm | 43 | Excision plus radiation | 17% |
| 9, margins < 5 mm | 197 | Mastectomy | 0% |
| All 10, 11, 12 | 389 | Mastectomy | 7% |
The USC/VNPI assigns DCIS patients scores (4-12) based on tumor size, margin width, grade, age, and comedo necrosis.
The above table includes data for 1673 patients with DCIS with 86 months of follow-up.
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What about stage 0, clear margins?
Prognosis?
Dawna, You need to plug in YOUR info — size & grade of DCIS, margins and your age will give you YOUR number.
Best to use the VNPI in conjunction with YOUR biology from YOUR DCIS tissue sample. Check out DCISionRT: https://preludedx.com/patients/
Hi, thank you for the information.
I am medical student, currently a little confused,
May I just confirm that Van Nuys prognostic index is done after lumpectomy,
to determine if futher radiation or mastectomy is needed, right?
Thank you.
Yes, the VNPI is based on lumpectomy….re-excision is also included as an option if margins are inadequate
Thank You
My wife is a 5 and had a partial mastectomy. She’s 53, it was low grade and 28 mm, the margins were much more than 10 mm. She doesn’t want radiation radiation or medication. The doctors don’t know what the best answer is. She is changing to a much healthier lifestyle. But it’s such a hard decision. Any advice?
The science supports your wife’s decision… as do I. Please spend time reading the articles and books and watching videos here and on http://Www.DCIS411.com
Blessings for peace, health, ease and grace 🙏
I am 83, DCIS High grade, margins 1 mm with reconstruction, size 16 mm and one doctor says “no way for radiation” he added, “I moved healthy tissue into your breast, why irradiate it?” The radiologist says it’s “large and high grade, radiation indicated” and Stanford said “it’s up to you,” and UCLA said, “Don’t. the risks to you are greater than the benefits.” So what do I do?