# Comparative Analyses of Van Nuys Prognostic Index and NCCN Guidelines in Ductal Carcinoma In Situ Treatment in a Brazilian Hospital

## TL;DR

This study compares two risk stratification tools for DCIS treatment in a Brazilian hospital and finds that using NCCN guidelines could reduce local recurrence rates.

## Contribution

The study evaluates the effectiveness of integrating VNPI with NCCN guidelines for DCIS treatment in a specific patient population.

## Key findings

- VNPI classified 38.8% of patients as low risk, while NCCN classified only 12.9% as low risk.
- NCCN guidelines could potentially reduce local recurrence rates by 5.6% when integrated with VNPI.
- 18 recurrences were observed, with 5.2% as DCIS and 10.3% as invasive cancer.

## Abstract

Background: Ductal carcinoma in situ (DCIS) is a precursor of invasive breast cancer and its early diagnosis and treatment are essential to prevent progression and recurrences. Risk stratification guidelines, such as the Van Nuys Prognostic Index (VNPI) and those by the National Comprehensive Cancer Network (NCCN), help guide appropriate treatment. This study compares VNPI recommendations for DCIS patients treated at Hospital do Servidor Público Estadual de São Paulo (HSPE) with NCCN guidelines, focusing on treatment conducted and recurrence rates. Methods: This retrospective, cross-sectional study reviewed medical records of 145 patients treated for DCIS at HSPE between January 1996 and June 2022, with a mean follow-up of 60.3 months. Results: Based on VNPI, 38.8% were low risk, 53.2% intermediate risk, and 7.8% high risk. NCCN guidelines classified only 12.9% as low risk and 87.1% as high risk. Treatment included breast-conserving surgery (BCS) with radiotherapy (43.1%), BCS alone (38.8%), and mastectomy (18.1%). There were 18 recurrences (15.5%): 5.2% as DCIS and 10.3% as invasive cancer. Of these recurrences, 5.6% occurred in patients who, according to NCCN, would have received BCS with radiotherapy or mastectomy. Conclusion: By integrating the VNPI with NCCN treatment guidelines, the NCCN’s recommendations could potentially reduce local recurrence rates by 5.6%. However, further studies are necessary to evaluate the long-term impact of these guidelines on overall survival outcomes.