Breast Cancer Awareness Month – DCIS – USC / Van Nuys Prognostic Index

• The University of Southern California / Van Nuys Prognostic Index (USC/VNPI) estimates which patients with ductal carcinoma insitu (DCIS) can be managed by:
  • Excision alone
  • Excision plus radiation
  • Mastectomy
•  There were 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:
      • They were:
        • Size of DCIS
        • Margin width
    • A score from 3 to 9 was derived by assigning 1, 2, or 3 points to each of the three variables as shown:

Table 1. 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.
      • Those from ages 40 to 60 years, a score of 2.
      • Those older than age 60 years, 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.
      • Those 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 and 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

REFERENCES

 

 

• Rodrigo Arrangoiz MS, MD, FACS cirujano de mama / cirujano oncology y miembro de Sociedad Quirúrgica S.C en el America British Cowdray Medical Center en la ciudad de Mexico:
  • Es experto en el manejo del cáncer de mama.

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

#Arrangoiz

#Surgeon

#Cirujano

#SurgicalOncologist

#CirujanoOncologo

#BreastSurgeon

#CirujanodeMama

#CancerSurgeon

#CirujanodeCancer

http://www.sociedadquirurigca.com