Value of the Van Nuys Prognostic Index in prediction of recurrence of ductal carcinoma <i>in situ</i> after breast-conserving surgery

Boland, G.P.; Chan, Kai Chio; Knox, W.F.; Roberts, Stephen A.; Bundred, Nigel

doi:10.1002/bjs.4051

Cited by 89 publications

(47 citation statements)

References 25 publications

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“…However, this result should be weighed up against the 12% rate observed at 5 years in a series of low-risk patients (Wong et al, 2006). On the other hand, the Van Nuys Prognostic Index (VNPI), combining tumour size, grade and margin width, was used to select 'low-risk' patients not requiring RT (Silverstein et al, 1996), but was widely criticised in two large American and English studies including 222 and 237 patients, respectively (Boland et al, 2003;MacAusland et al, 2007). A recent Italian study (Di Saverio et al, 2008) including 259 patients also used VNPI and concluded in the absence of statistically significant advantage in the CS þ RT vs the CS group.…”

Section: Discussionmentioning

confidence: 99%

Breast-conserving surgery with or without radiotherapy vs mastectomy for ductal carcinoma in situ: French Survey experience

et al. 2009

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physicians throughout France prospectively recruited 1289 ductal carcinoma in situ (DCIS) patients and collected data on diagnosis, patient and tumour characteristics, and treatments. Median age was 56 years (range, 30 -84). Ductal carcinoma in situ was diagnosed by mammography in 87.6% of patients. Mastectomy, conservative surgery alone (CS) and CS with radiotherapy (CS þ RT) were performed in 30.5, 7.8 and 61.7% of patients, respectively. Thus, 89% of patients treated by CS received adjuvant RT. Sentinel node biopsy (SNB) and axillary dissection (AD) were performed in 21.3 and 10.4% of patients, respectively. Hormone therapy was administered to 13.4% of the patients (80% tamoxifen). Median tumour size was 14.5 mm (6, 11 and 35 mm for CS, CS þ RT and mastectomy, respectively, Po0.0001). Nuclear grade was high in 21% of patients, intermediate in 38.5% and low in 40.5%. Excision was considered complete in 92% (CS) and 88.3% (CS þ RT) of patients. Oestrogen receptors were positive in 69.8% of assessed cases (31%). Treatment modalities varied widely according to region: mastectomy rate, 20 -37%; adjuvant RT, 84 -96%; hormone treatment, 6 -34%. Our survey on current DCIS management in France has highlighted correlations between pathological features (tumour size, margin and grade) and treatment options, with several similar variations to those observed in recent UK and US studies.

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Section: Discussionmentioning

confidence: 99%

Breast-conserving surgery with or without radiotherapy vs mastectomy for ductal carcinoma in situ: French Survey experience

et al. 2009

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“…The association of COX-2 expression with nuclear grade in DCIS confirms the findings of Shim et al (2003). Since nuclear grade is an independent marker of DCIS local recurrence (Silverstein et al, 1996;Boland et al, 2003a), further study is warranted to determine whether COX-2 is independent of grade with regard to the risk local DCIS recurrence following breast conservation.…”

Section: Discussionmentioning

confidence: 99%

COX-2 expression is associated with an aggressive phenotype in ductal carcinoma in situ

et al. 2004

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Cyclooxygenase type-2 (COX-2) is overexpressed in malignant tumours including breast cancers, though the mechanism of upregulation is unclear. This study aimed to determine COX-2 expression in ductal carcinoma in situ (DCIS) in comparison to invasive breast cancer (IBC) and normal breast, and also to investigate the relationship of COX-2 expression with HER-2 expression, oestrogen receptor (ER), tumour grade and cellular proliferation (Ki67) in DCIS. Cyclooxygenase type-2, HER-2, ER and Ki67 expression were determined by immunohistochemistry on paraffin tissue sections of DCIS (n ¼ 187), IBC (n ¼ 65) and normal breast reduction tissue (n ¼ 60). Cyclooxygenase type-2 expression in DCIS (67%, Po0.001) and IBC (63%, Po0.001) was significantly greater than in normal breast (23%). There was no difference in COX-2 expression level between DCIS and IBC (P ¼ 0.87) or between normal breast from reduction mammoplasty tissue and normal breast ducts around DCIS (22%, P ¼ 0.29). In DCIS, COX-2 expression was associated with higher cellular proliferation rates (Po0.0001), nuclear grade (P ¼ 0.003), with ER negativity (P ¼ 0.003) and with HER-2 positivity (Po0.0001). Cyclooxygenase type-2 expression is upregulated in in situ breast cancer and is associated with surrogate markers of an aggressive DCIS phenotype including nonoestrogen-regulated signalling pathways. Cyclooxygenase type-2 inhibition may potentially prevent the development of ER-positive and ER-negative breast cancers.

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“…Classification systems based on various differentiation aspects of DCIS seem to be clinically relevant, as the nuclear grade is strongly associated with disease recurrence (Ringberg et al, 2000;Boland et al, 2003). Unfortunately, the interobserver reproducibility of the analyses is low (Douglas-Jones et al, 2000;Wells et al, 2000) and there is still a need for a more objective basis for the classification of DCIS.…”

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Tissue microarray analyses of G1/S-regulatory proteins in ductal carcinoma in situ of the breast indicate that low cyclin D1 is associated with local recurrence

et al. 2003

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Ductal carcinoma in situ (DCIS) of the breast constitutes about 10% of all diagnosed breast cancers and, despite surgical removal, it may recur, either as DCIS or invasive breast cancer. Nuclear grade and growth pattern according to Andersen et al as well as surgical margins are factors that have been used to predict local recurrence, but ideally a set of tumour-specific factors should be identified and used as prognostic markers. Many cell cycle regulatory gene products have been shown to be involved in the formation of tumours and are either oncogenes or suppressor genes and involved in key processes in the transformation. We therefore characterised the cell cycle regulators cyclin E, cyclin D1, p27 and p16 in a material of DCIS cases arranged in a tissue microarray. With a manual tissue arrayer, 52% of the initial 177 DCIS samples were successfully targeted allowing immunohistochemical analyses of all four proteins in 92 cases of DCIS. As also observed in invasive breast cancer, there was a trend indicating that DCIS cases with high cyclin D1 were cyclin E low and oestrogen receptor-positive, whereas cyclin E high DCIS cases were cyclin D1 low and oestrogen receptor-negative. For the 64 patients that did not receive postoperative radiotherapy, there were 16 local recurrences (eight DCIS and eight invasive breast cancer) during a mean follow-up time of 63 months. Cyclin E, p27 or p16 were not associated with local recurrence, but interestingly cyclin D1 was significantly and inversely associated with local recurrence, both using univariate and multivariate analyses. In summary, using a tissue array approach we have shown that cyclin D1, besides growth pattern, is a prognostic marker for local recurrence in DCIS.

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Value of the Van Nuys Prognostic Index in prediction of recurrence of ductal carcinoma in situ after breast-conserving surgery

Abstract: Excision margin width is the most important predictor of local recurrence after breast-conserving surgery for DCIS. The VNPI lacked discriminatory power for guiding further patient management.

Cited by 89 publications

References 25 publications

Breast-conserving surgery with or without radiotherapy vs mastectomy for ductal carcinoma in situ: French Survey experience

Breast-conserving surgery with or without radiotherapy vs mastectomy for ductal carcinoma in situ: French Survey experience

COX-2 expression is associated with an aggressive phenotype in ductal carcinoma in situ

Tissue microarray analyses of G1/S-regulatory proteins in ductal carcinoma in situ of the breast indicate that low cyclin D1 is associated with local recurrence

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