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