Van Nuys Prognostic Index

Ductal carcinoma in situ patients with USC/VNPI scores of 4, 5 or 6 can be considered for treatment with excision only. Patients with intermediate scores (7, 8, or 9) should be considered for treatment with radiation therapy or be reexcised if margin width is less than 10 mm and cosmetically feasible. Patients with USC/VNPI scores of 10, 11, or 12 exhibit extremely high local recurrence rates, regardless of irradiation, and should be considered for mastectomy, generally with immediate reconstruction or reexcision if technically possible.

Presented at the Fourth Annual Meeting of the American Society of Breast Surgeons, Atlanta, Georgia, April 30–May 4, 2003. Melvin J Silverstein, M.D

Updated VNPI Scoring Index

Parameter

1 Point

2 Points

3 Points

Size

<=15 mm

16-40 mm

>40 mm

Grade

Grade I-II

Grade I-II + necrosis

Grade III

Margin

>= 10 mm

1-9 mm

<1 mm

Age

>60

40-60

<40

2003 Update PMID 14682107 — “An argument against routine use of radiotherapy for ductal carcinoma in situ.” (Silverstein MJ, Oncology (Williston Park). 2003 Nov;17(11):1511-33; discussion 1533-4, 1539, 1542 passim.)
o 706 patients with DCIS, 426 excision alone, 280 excision + RT.

 

At the 2014 Miami Breast Cancer Conference, Dr. Silverstein presented the latest more refined USC/VNPI, which include 5 times as many patients, with 86 months of follow-up.
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 ❤ mm 117 Excision plus radiation 14%
8, margins ≥3 mm 128 Excision plus radiation 14%
8, margins ❤ 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 comedonecrosis.

The above table includes data for 1673 patients with DCIS with 86 months of follow-up.

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Responses

  1. What is the definition of recurrence in this study? Is it DCIS or invasive cancer.

    • A recurrence could be either DCIS or invasive cancer. Most studies show if a recurrence happens, it is invasive about 1/2 the time.


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