Nottingham prognostic index
By using multivariate analysis, 3 factors were found to be significant: tumour grade, number of lymph nodes involved and size of the tumour.
Tumour grade (G) gives a score 1-3 based on the modified Bloom-Richardson grading
Lymph node involvement (L) gives a score 1-3
- No nodes
- 1-3 nodes
- >3 nodes
With sentinel lymph node sampling replacing axillary sampling/clearance, a negative sentinel lymph node is regarded as node negative.
With tumour size in cm (S) factored in, the NPI can be worked out by:
This has been shown to give the following prognoses:
|NPI score||Prognosis||5-year survival|
As a semi-quantitative score, other divisions are possible, e.g. into 5 categories.
The NICE DG10 guidelines use the 4-category division indicated in the table, recommending Oncotype DX testing in moderate risk tumours to help guide decisions on adjuvant chemotherapy.
- ↑ Haybittle JL, Blamey RW, Elston CW, Johnson J, Doyle PJ, Campbell FC, Nicholson RI, Griffiths K. A prognostic index in primary breast cancer. British journal of cancer. 1982 Mar; 45(3):361-6.
- ↑ Williams MR, Hinton CP, Todd JH, Morgan DA, Elston CW, Blamey RW. The prediction of local or regional recurrence after simple mastectomy for operable breast cancer. The British journal of surgery. 1985;72:721-3.
- ↑ Todd JH, Dowle C, Williams MR, Elston CW, Ellis IO, Hinton CP, et al. Confirmation of a prognostic index in primary breast cancer. British journal of cancer. 1987;56:489-92.
- ↑ https://www.nice.org.uk/guidance/dg10/chapter/5-Outcomes