Abstract
Ductal carcinoma in situ, a marginal fraction of the mammary gland diseases, is recognized in 25% of breast cancers detected with mammographic screening. The aim of the study was to assess the prognostic value of Van Nuys Prognostic Index, serving to determine the method of treatment according to the recurrence risk. From the 737 of cases of DCIS detection patients treated in our department in the years 1996–2011. The remaining 525 patients whose treatment began from excision of local DCIS and whose further course of treatment was determined after histopathological examination, who were left for observation, treated with lumpectomy and radiotherapy or mastectomy, were qualified for the assessment of mentioned index (Online Appendix 1- Figure S1). The 5-, 10- and 15- year disease recurrence-free survival for the group of 525 patients was 88%, 74% and 62%, respectively. The percentage of 5-, 10- and 15-year disease recurrence-free survival in patients treated in compliance with the VNP Index in individual risk groups did not differ in a statistically significant way. In the low-risk group the percentage of recurrences after local excision, after 5, 10 and 15 years of observation amounted to 8.8%, 22.8% and 28.8%. In patients from this group, the recurrence risk after breast conserving treatment and mastectomy was 2% and 0%, respectively. VNP Index is not an optimal tool for patients with DCIS. It can be helpful only in some clinically difficult cases as one of methods of assessing the risk of recurrence.
Highlights
Ductal carcinoma in situ (DCIS) used to account for a marginal fraction of the mammary gland diseases
The aim of the study was to assess the prognostic value of The University of Southern California/Van Nuys Prognostic Index (UC/VNPI), published in 2003, serving to determine the method of treatment according to the recurrence r isk[9]
The remaining 525 consecutive patients whose treatment began from excision of a local DCIS and whose further course of treatment was determined after a histopathological examination, who were left for observation, treated with lumpectomy and radiotherapy or mastectomy, were qualified for the assessment of the VNPI according to the 2003 criteria[9]
Summary
Ductal carcinoma in situ (DCIS) used to account for a marginal fraction of the mammary gland diseases. The methods of treating DCIS include excision of the lesion without radiation therapy, excision of the lesion with adjuvant radiotherapy (breast conserving therapy) and mastectomy. The University of Southern California/Van Nuys Prognostic I ndex[9], published in 2003 constitutes a numerical algorithm which allows to assess the recurrence risk and indicates the optimal method of treatment. A score ranging from [4,5,6] signifies a low recurrence risk group and constitutes an indication for the performance of a local excision alone, a score of [7,8,9] is an indication for adjuvant radiotherapy after excision (breast conserving treatment) while a score of 10 -12 suggests the necessity of performing mastectomy[9]. The VNPI was developed on the basis of a repeatedly up-dated and modified retrospective analysis of patients treated for DCIS, patients not being subjected to randomization as regards the method of treatment[8,9,10,11]
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