Re:Off topic -Chuck, Nancie or anyone who knows

[Guest guest]

Here's a site that explains the Nottingham Prognostic Index [NPI];

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<http://74.125.113.132/search?q=cache:xriYDHACnlUJ:poptop.hypermart.net/brcanpi.\

html+Nottingham+Prognostic+Index+(NPI) & hl=en & ct=clnk & cd=1 & gl=us>

..

I believe it is used to determine the need for some types of therapy,

probably chemo following surgery but I'm very hazy on that point. I

think a score of 2 is very good. I'm also under the impression that " in

situ " means it has not spread.

It appears the total score is made up of three items: Tumor size, tumor

grade and axillery lymph node status. See below, or google " Nottingham

Prognostic Index [NPI] " .

Best of luck to both of you,

..

..

> *The *NOTTINGHAM* *PROGNOSTIC* *INDEX* (*NPI*)*

>

> The *NPI* status was 1st published about 1992 as an attempt at using

> some fairly objective parameters to determine the odds that a newly

> diagnosed case of invasive ductal adenocarcinoma would benefit from

> adjuvant chemotherapy. By whatever means, the status of the axillary

> lymph nodes must be determined at least as to whether any nodes are

> positive for metastatic cancer (ALN+) or negative (ALN-). If any

> positive nodes, more details are needed. The studies looked at

> " overall survival " (OS) at 15 years post diagnosis. This grouping is

> just an initial categorization; many other patient-specific factors

> are taken together to make a final decision.

>

> *SIZE:*

>

> Decisions may have to be made prior to having the whole tumor out and

> size-measurable. By whatever measure, the following are the criteria

> for assignment of size points (such are finally, ultimately, assigned

> from the pathology tissue studies):

> bullet maximum tumor size in centimeters:_____________times

> 0.2=________points.

>

> *TUMOR GRADE:*

>

> bullet from 1 (better) to 3 (worse), by whatever system, the tumor

> grade=___________points

>

> * AXILLARY LYMPH NODE STATUS:*

>

> Use *one* of the following scoring methods:

> bullet Classical scoring system:

> bullet negative

>

nodes...........................................................................\

....1

> point

> bullet positive nodes, low axillary

> only..........................................2 points

> bullet positive nodes, internal mammary

> only..............................2 points

> bullet positive nodes, axillary plus internal mammary............3

> points

> bullet positive nodes, apical axillary node

> positivity...............3 points

>

> bullet Alternative scoring system:

> bullet negative

>

nodes...........................................................................\

.....1

> point

> bullet positive nodes, 1 to 3

> positive..............................................2 points

> bullet positive nodes, 4 or

> more.........................................................3 points

>

> *CALCULATION FORMULA:*

>

> **NPI* point sum= tumor-size pts [_____] plus grade pts [_____]

> plus lymph node pts [_____]=________total *NPI* points*

>

>

> **NPI* DECISION GROUPS*

> *Groups:* *80% OS @ 15 yrs

> if *NPI*

> <3.4 sum* *42% OS @ 15 yrs

> if *NPI*

> 3.4-5.4 sum* *13% OS @ 15 yrs

> if *NPI*

> >5.4 sum*

> *Conclusions:

> as to need for

> adjuvant chemo. treatment*

> *need is doubtful*

>

>

> *MAY BENEFIT

> with chemo.*

>

>

> *chemo needed*

>

>

..

..

..

> Posted by: " MSE " knockneed@...

>

<mailto:knockneed@...?Subject=%20Re%3AOff%20topic%20-Chuck%2C%20Nancie%20o\

r%20anyone%20who%20knows>

> knockneed <knockneed>

>

>

> Sun Dec 28, 2008 1:25 pm (PST)

>

> My niece diagnosed w/breast cancer on Xmas Eve. She is 32, never smoked,

> doesn't drink, breast fed two babies, is a marathoner and an equestrian.

> Never had a mammogram as no family history so she wouldn't be due to have

> such exam until age 40. Unfortunately, the lump was big enough that she

> found it herself while securing her bra.

>

> I have seen the pathology report and remember enough of it to say that she

> is diagnosed with (......this word I don't remember) in situ ductal

> carcinoma, Nottingham 2, Apocrine . There are two tumors - one is 4mm ,

> the other is 2mm.

>

> So, I've looked up apocrine - which means sweat gland, Nottingham is a

> prognosis scale , in situ ductal means milk gland.

>

> My questions are -1.) is Nottingham2 good news or bad? All my googles

> only discribe the prognosis method/theory behind the Nottingham scale. I

> don't seem to be able to find out what a scale of 2 means. 2.) Does the

> apocrine inclusion mean that the in situ ductal has travelled from the

> milk

> glands to the sweat glands - an indication of metastatic breast cancer? Is

> the fact that there are two tumors indicative of metastatic breast

> cancer or

> is more than one tumor common with in ductal in situ cancer?

>

> The tumors are underneath the nipple in the right breast only - MRI

> results

> indicate no chest wall tumors or lymph node involvement. Surgeon has been

> contact and we are awaiting an appointment. It is possible that I will be

> patient advocate for her and I don't understand most of what I'm

> reading on

> the net.

>

> Can anyone make this any c learer , in layman's language, so that I am

> prepared if I go with her to surgeon.

>

> Thanks

>

> --

> mse