Van Nuys Prognostic Index

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.

Van Nuys Prognostic Index
Parameter Score 1 Score 2 Score 3
Van Nuys Classification Group 1 Group 2 Group 3
Non high nuclear grade without necrosis Non-high nuclear grade with necrosis High nuclear grade with or without necrosis
Margins ≥10 mm 1–9 mm <1 mm
Size <15 mm 16–40 mm >40 mm
Age >60 40–60 <40

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.

At the 2014 Miami Breast Cancer Conference, Dr. Mel Silverstein presented the latest more refined USC/VNPI, which include 5 times as many patients, with 86 months of follow-up.
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.

10 thoughts on “Van Nuys Prognostic Index”

  1. Dawna Jangel said:

    What about stage 0, clear margins?

  2. Carefreeting said:

    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.

  3. Ann galluzzo said:

    Thank You

  4. 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?

  5. Jain Fairfax said:

    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?

  6. Greeat read

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