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Prognosis in Breast Cancer


Accurate prediction of prognosis is critical in guiding appropriate therapy and its timing. The list below gives the main prognostic indicators in routine practice. There is a very major drive at the present time to define molecular and genetic markers to refine this process further.


Assessment of Prognosis



Tumour grade





Axillary Lymph Node Status





Tumour size





ER status





Her2 Status





The Nottingham Prognostic Index (NPI)



The Nottingham Prognostic Index was originally derived from clinico-pathological correlation of a large series of symptomatic breast cancer patients. It is likely that it will need to be revised in the near future to allow its effective application to screening patients.

The NPI is calculated as follows:

Three elements make up the final score:

Numerical Grade:

  • 1, 2 or 3


Lymph node score:


Tumour size:


To calculate score ADD Numerical Grade, Lymph node score and 0.2* tumour size in Cm

Examples:


For a 10mm Grade 2 carcinoma with 2/4 nodes positive the NPI is: 4.2 - (Derived from: 2 + 2 +(0.2*1.0))

For a 24mm Grade 1 carcinoma with 4/10 nodes positive the NPI is: 4.12 - (Derived from: 1 + 3 +(0.2*2.4))

For a 15mm Grade 3 carcinoma with all nodes negative the NPI is: 4.3 - (Derived from: 3 + 1 +(0.2*1.5))




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