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.|
|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.