Which of the following correctly describes the Van Nuys Prognostic Index (VNPI) used in managing ductal carcinoma in situ (DCIS) of the breast?
- A It uses ER status, HER2 amplification, Ki-67, and tumor size to determine adjuvant chemotherapy need
- B It scores histological grade, lymphovascular invasion, lymph node status, and margin to predict invasive recurrence
- C It scores nuclear grade, necrosis, margin width, and patient age — total score guides whether excision alone, excision + RT, or mastectomy is appropriate ✓
- D It is applied only to Paget's disease of the nipple to stage underlying malignancy
Correct answer: C. It scores nuclear grade, necrosis, margin width, and patient age — total score guides whether excision alone, excision + RT, or mastectomy is appropriate
Explanation
The VNPI assigns scores of 1-3 to each of four parameters: nuclear grade (non-high, intermediate, high), presence of necrosis (absent, present), surgical margin width (>10mm, 1-9mm, <1mm), and patient age (<40, 40-60, >60). The total score (4-12) stratifies management: scores 4-6 suggest excision alone; 7-9 suggest excision plus radiotherapy; 10-12 suggest mastectomy. This index is specific to DCIS and does not apply to invasive or Paget's disease assessment in the same way.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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