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.

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.

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 Nonhigh nuclear grade with necrosis High nuclear gradewith 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 ❤ 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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