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Van Nuys Prognostic Index Ductal Carcinoma In Situ

Purpose: To calculate the Van Nuys prognostic index for ductal carcinoma in situ.

Description

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.


Parameter

Finding

Points

size of tumor, in mm

<= 15 mm

1

 

16-40 mm

2

 

>= 41 mm

3

margins

>= 10 mm

1

 

1-9 mm

2

 

< 1 mm

3

pathologic classification

low or intermediate grade without necrosis

1

 

low or intermediate grade with necrosis

2

 

high grade, with or without necrosis

3

 

Van Nuys prognostic index =

= (points for size) + (points for margins) + (points for pathologic classification)

 

Interpretation:

• minimum score 3

• maximum score 9

 

Prognostic Index

Risk Group

3 or 4

low risk

5, 6 or 7

intermediate risk

8 or 9

high risk

 

 

Prognostic Index

Margin Points

Treatment Recommendation

3 or 4

 

do not benefit from radiation therapy and can be treated by excision alone

5, 6 or 7

1

benefit from radiation therapy

5, 6 or 7

2 or 3

re-excision of biopsy site may be sufficient to preclude need for radiation therapy

8 or 9

 

post-excisional radiation therapy with serious consideration for mastectomy

 

Limitations (Tavassoli):

• Difficulty in defining size in some lesions.

• Results may be affected by how the specimen is oriented and processed.


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Specialty

Objective

ICD-10