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.
Ductal carcinoma in situ 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 reexcised 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 ❤ mm | 117 | Excision plus radiation | 14% |
| 8, margins ≥3 mm | 128 | Excision plus radiation | 14% |
| 8, margins ❤ 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 comedonecrosis.
The above table includes data for 1673 patients with DCIS with 86 months of follow-up.
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