Rudloff et al developed a nomogram for predicting the risk of local recurrence following breast-conserving therapy for ductal carcinoma in situ (DCIS). This can help to identify a patient who may benefit from more aggressive management. The authors are from Memorial Sloan-Kettering Cancer Center in New York City.
Patient selection: woman with DCIS treated with breast-conserving surgery
Parameters:
(1) age at diagnosis of DCIS in years
(2) family history of breast cancer
(3) initial presentation
(4) radiation therapy after surgery
(5) adjuvant endocrine therapy
(6) nuclear grade
(7) necrosis (comedonecrosis)
(8) surgical margins
(9) number of excisions
(10) year surgery performed
|
Age |
Points |
|
< 25 |
97.2 |
|
25 to 90 |
(-1.495 * (age in years)) + 134.58 |
|
> 90 |
0 |
|
Parameter |
Finding |
Points |
|
family history |
no |
0 |
|
|
yes |
30 |
|
initial presentation |
radiologic detection |
0 |
|
|
clinical detection |
33.5 |
|
radiation therapy |
yes |
0 |
|
|
no |
100 |
|
adjuvant endocrine therapy |
yes |
0 |
|
|
no |
76 |
|
nuclear grade |
low |
0 |
|
|
intermediate or high |
26.5 |
|
necrosis |
absent |
0 |
|
|
present |
12.8 |
|
margins |
negative |
0 |
|
|
positive or close |
56 |
|
number of excisions |
1 to 2 |
0 |
|
|
3 or more |
53.2 |
|
year of surgery |
<= 1998 |
57.4 |
|
|
>= 1999 |
0 |
total score =
= SUM(points for all 10 parameters)
Interpretation:
• minimum score: 0
• maximum score: 500
• The higher the score the greater the risk of local ipsilateral tumor recurrence.
|
Total Points |
Probability of Local Recurrence within 5 Years of the Breast Conserving Surgery |
|
< 195 |
< 5% |
|
195 to 488 |
(0.000601 * ((points)^2)) - (0.2251 * (points)) + 26.37 |
|
> 488 |
> 60% |
|
Total Points |
Probability of Local Recurrence within 10 Years of the Breast Conserving Therapy |
|
< 146 |
< 5% |
|
146 to 468 |
(0.000597 * ((points)^2)) - (0.1650 * (points)) + 16.68 |
|
> 468 |
> 70% |
Purpose: To predict the risk of local recurrence following breast -conserving therapy for DCIS based on the study of Rudloff et al.
Specialty: Hematology Oncology, Surgery, general, Obstetrics & Gynecology
Objective: other testing, selection
ICD-10: D05.1,
