Dr. Silverstein Gives an Overview of the VNPI

Melvin J. Silverstein, MD, FACS, director, Breast Program Hoag Memorial Hospital, professor of surgery, Keck School of Medicine, University of Southern California, gives an overview of the Van Nuys Prognostic Index for DCIS.

The Van Nuys Prognostic Index is based on five markers: tumor size, margin width, nuclear grade, age, and comedonecrosis. Possible scores range from 4 to 12. Low scores (4, 5, and 6) are typically seen in older patients with well excised, small, low-grade lesions, while high scores (10, 11, and 12) are typically seen in younger patients with poorly excised, larger, high grade lesions.

Patients with low scores do not need radiation therapy, as the predicted chance of recurrence is low compared with patients in the high group. Silverstein says this is not enough of a benefit for radiation to be worth it.