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

  • The USC / VNPI:
    • Estimates which patients with DCIS can be managed by:
    • Excision alone vs
    • Excision plus radiation vs
    • 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:
      • They were:
        • Size of DCIS and margin width
    • A score from 3 to 9 was derived by:
      • Assigning 1, 2, or 3 points to each of the 3 variables as shown below in the Table 1:
  • Patients who scored 3 or 4:
    • Derived little benefit from radiation
  • Patients who scored 5, 6, or 7:
    • Derived substantial benefit from radiation
  • Patients who scored 8 or 9:
    • Had a high risk of relapse despite radiation and are best managed:
      • By mastectomy
  • In 2003:
    • The name became the University of Southern California / Van Nuys Prognostic Index
    • A 4th variable was added to the score:
      • Patients who were younger than age 40 years:
        • Received a score of 3
      • Patients from ages 40 to 60 years:
        • Received 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 five-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, and for patients who score 9 and have margins ≥ 5 mm
      • Mastectomy is suggested for patients:
        • Who score 8 and have margins < 3 mm, who score 9 and have margins < 5 mm, and for all patients who score 10, 11, or 12 to keep the local recurrence rate less than 20% at 12 years
  • REFERENCES
    • Silverstein MJ. The University of Southern California/Van Nuys Prognostic Index for ductal carcinoma in situ of the breast. Am J Surg. 2003;186:337-343.
    • Silverstein MJ, Lagios MD. Choosing treatment for patients with ductal carcinoma in situ: fine tuning the University of Southern California/Van Nuys Prognostic Index. J Natl Cancer Inst Monogr. 2010;2010:193-196.
    • Silverstein MJ, Lagios MD. Treatment selection for patients with ductal carcinoma in situ (DCIS) of the breast using the University of Southern California/Van Nuys (USC/VNPI) Prognostic Index. Breast J. 2015;21:127-132.
    • Silverstein MJ, Lagios MD, Craig PH, et al. A prognostic index for ductal carcinoma in situ of the breast. Cancer. 1996;77:2267-2274.

#Arrangoiz #BreastSurgeon #CancerSurgeon #BreastCancer #SurgicalOncologist

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