Management of ductal carcinoma in situ can be problematic, due to the heterogenous nature of the disease process. Objective evaluation of the lesion can help decide if and what additional therapy is needed. Features found to aid in the decision making process include: size of lesion, distance to surgical margins and pathologic grade with or without luminal necrosis. The Van Nuys Prognostic Index (VNPI) uses these features to predict the patient risk and to guide therapeutic decisions.