University of Southern California / Van Nuys Prognostic Index (USC / VNPI)

The University of Southern California / Van Nuys Prognostic Index (USC / VNPI):
- Estimates which patients with DCIS can be managed by:
  - Excision alone
  - Excision plus radiation
  - Versus those who require mastectomy.
- There are three groups of patients in the index:
  - Group 1:
    - Patients have non-high nuclear grade DCIS without necrosis
  - Group 2:
    - Patients have non-high nuclear grade DCIS with necrosis
  - Group 3:
    - Patients have high nuclear grade DCIS with or without necrosis

The original “Van Nuys Prognostic Index,” introduced in 1996:
- Had two additional variables:
  - Size of the DCIS
  - Margin width
- A score from 3 to 9 was derived:
  - By assigning 1, 2, or 3 points to each of the three variables

Table. **Van Nuys Prognostic Index**
	1 Point	2 Points	3 Points
Group	1	2	3
Margin	≥ 10 mm	1 to 9 mm	< 1 mm
Size	≤ 15 mm	16 to 40 mm	> 41 mm

Patients who scored 3 or 4:
- Derived little benefit from radiation
Those who scored 5, 6, or 7:
- Derived substantial benefit from radiation
Those who scored 8 or 9:
- Had a high risk of relapse despite radiation:
  - Best managed by mastectomy

In 2003:
- The name became the University of Southern California / Van Nuys Prognostic Index:
  - And a 4th variable was added to the score:
    - Patients who were younger than age 40 years:
      - Received a score of 3
    - Patients ages 40 to 60 years:
      - Received a score of 2
    - Patients older than age 60 years:
      - Received a score of 1.
  - The range of possible scores then became:
    - 4 to 12
  - Patients with a score of 4, 5, or 6:
    - Did not receive a statistically significant benefit from radiation
  - Patients with scores of 7, 8, and 9:
    - Who were treated with radiation:
      - Received a significant reduction in local disease-free recurrence:
        
        Of 12% to 15%
  - Patients with scores of 10, 11, and 12:
    - Had a local recurrence rate of almost 50% at 5 years despite radiation
By 2010 the number of patients was large enough to allow analysis by individual scores as opposed to groups of scores, and the following was reported:
- To achieve a local recurrence rate of less than 20% at 12 years:
  - These data support excision alone:
    - For all patients scoring 4, 5, or 6
    - Patients who score 7 but have margin widths ≥ 3 mm.
- Excision plus radiation therapy achieves the less than 20% local recurrence requirement at 12 years for:
  - Patients who score 7 and have margins < 3 mm
  - Patients who score 8 and have margins ≥ 3 mm
  - Patients who score 9 and have margins ≥ 5 mm.
- Mastectomy is suggested for:
  - Patients who score 8 and have margins < 3 mm
  - Patients who score 9 and have margins < 5 mm
  - All patients who score 10, 11, or 12:
    - To keep the local recurrence rate less than 20% at 12 years

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