Van Nuys Prognostic Classification:
- Group 1 Non-high nuclear grade without necrosis
- Group 2 Non-high nuclear grade with necrosis
- Group 3 High nuclear grade with or without necrosis
Original Van Nuys Prognostic Index (VNPI) Scoring Index
Parameter |
1 Point |
2 Points |
3 Points
|
Van Nuys Classification |
Group 1 |
Group 2 |
Group 3
|
Clear Margin |
> or = 10 mm |
1-9 mm |
<1 mm
|
Lesion Size |
< or = 15 mm |
16-40 mm |
> 41 mm
|
Final Score
Group 1 |
3 - 4 points |
3.8% Recurrence |
93% 8 year disease free
|
Group 2 |
5 - 7 points |
11.1% Recurrence |
84% 8 year disease free
|
Group 3 |
8 - 9 points |
26.5% Recurrence |
61 % 8 year disease free
|
Updated USC / Van Nuys Prognostic Index (VNPI)
Parameter |
1 Point |
2 Points |
3 Points
|
Van Nuys Classification |
Group 1 |
Group 2 |
Group 3
|
Clear Margin |
> or = 10 mm |
1-9 mm |
<1 mm
|
Lesion Size |
< or = 15 mm |
16-40 mm |
> 41 mm
|
Age |
61 or older |
40 - 60 |
39 or younger
|
Updated USC / Van Nuys - Total Score
Score |
Local recurrence |
5-yr and 10-yr local RFS
|
4 - 6 points |
1% |
99% / 97%
|
7 - 9 points |
20% |
84% / 73%
|
10 - 12 points |
50% |
51% / 34%
|
References:
- 2003 Updated USC/VNPI PMID 14553846 Full text -- "The University of Southern California/Van Nuys prognostic index for ductal carcinoma in situ of the breast." (Silverstein MJ, Am J Surg. 2003 Oct;186(4):337-43.)
- Added age
- Score 4-6 : no statistical difference in 12-yr local RFS for pts treated with vs without RT
- Score 7-9 : 12-15% improvement with RT
- Score 10-12 : benefit with RT, but very high risk of recurrence despite RT
- Conclusion: Recommend excision alone for scores 4-6. RT for scores 7-9. Consider mastectomy for scores 10-12
- 1999 Subsequent report on margins: PMID 10320383 Full text, 1999 (1979-1998) — "The influence of margin width on local control of ductal carcinoma in situ of the breast." Silverstein MJ et al. N Engl J Med. 1999 May 13;340(19):1455-61.
- Retrospective. 469 pts. Pts treated until 1989 received post-op RT and those treated after 1989 did not. RT was 40-50 Gy to whole breast + 16-20 Gy boost. Tumors were assessed for histologic subtype, nuclear grade, comedonecrosis, maximal diameter, and margin width. Margins were classified as close or involved (<1 mm), intermediate (1 to <10 mm), or wide.
- RT decreased the recurrence rate for close or involved margins; for intermediate or wide margins, was not statistically different.
- Conclusion: RT is not necessary for margins > 10 mm.
- 1996 First report PMID 8635094 — "A prognostic index for ductal carcinoma in situ of the breast." Silverstein MJ et al (and Lewinsky BS). Cancer. 1996 Jun 1;77(11):2267-74.
- Came up with Van Nuys Prognostic Index (VNPI). Combines tumor size, margin width, histologic classification. Score 1-3 for each to arrive at a total score of 3-9.
- Evaluated 333 pts treated with excision alone or excision + RT.
- For pts with VNPI score of 3-4, excellent recurrence free survival (100% vs 97%) whether or not RT was used. For VNPI scores of 5-7, there was a 17% decrease (85% vs 68%) in RFS when RT was used. For score of 8-9, recurrence rate > 60% despite RT.
- Conclusion: recommend excision alone for score of 3-4, excision + RT for score of 5-7, and mastectomy for 8-9.
Alternative
- PMID 16750316 -- "Rationalization and regionalization of treatment for ductal carcinoma in situ of the breast." (Smith GL, Int J Radiat Oncol Biol Phys. 2006 Aug 1;65(5):1397-403.) Used classification below for cohort study:
Alternative
Parameter |
Age |
Size |
Histology
|
---|
0 Points
|
61+ |
<=15 mm |
Grade I-II
|
---|
1 Points
|
40-60 |
16-40 mm |
Grade I-II + Necrosis
|
---|
2 Points
|
<40 |
>40 mm |
Grade III
|
---|
- Low risk: 0
- Intermediate risk: 1-2
- High risk: 3-6