Six of the Best, Breast 09

Abstract

Aims: The Van Nuys prognostic index (VNPI) is a numerical algorithm based on tumour features and recurrence data from a large series of DCIS patients. It attempts to quantify easily measured prognostic factors in a reproducible fashion separating DCIS patients into three groups. The value of the VNPI will be determined by its reproducibility in other institutions. Methods: A total of 700 DCIS patients were identified from a prospective audit. Clinical and pathological data were assessed and a VNPI score was assigned to each woman retrospectively. Patients with a high score (8 or 9) usually had undergone mastectomy and were not considered in this analysis. Results: Median follow up was 5.8 years. A total of 423 patients underwent BCT. One hundred and seventy-nine women (42.4 per cent) received DXT. In the BCT group, 80 patients had a score of 3 or 4 with 8 LR (10 per cent). In the BCT/DXT group, 42 patients had a score of 3 or 4 with 1 LR (3 per cent). When a score of 4 was considered alone recurrences were 14 per cent (BCT alone) and 3 per cent (BCT/DXT). In the group with scores of 5, 6 or 7, 115 patients underwent BCT alone with 49 (42 per cent) recurrences. Seventy-six patients underwent BCT/DXT with nine (9 per cent) recurrences. Conclusion: In this study, the VNPI remains useful in predicting recurrence and guiding therapies. An intermediate score in the BCT alone group in this analysis had a high chance of local recurrence. Adjuvant DXT reduced the recurrence rate. In contrast to other studies, BCT alone patients with a low VNPI (3 or 4) appeared to benefit from adjuvant DXT.