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What is a Nottingham Score?

Published in Breast Cancer Prognosis 2 mins read

A Nottingham Score, more accurately known as the Nottingham Prognostic Index (NPI), is a tool used to predict the survival rate of individuals with operable primary breast cancer.

Here's a breakdown:

  • Purpose: The NPI aims to provide an estimate of long-term prognosis (likely outcome) after surgical treatment for breast cancer. It helps doctors and patients make informed decisions about treatment options and follow-up care.

  • Calculation: The NPI is calculated using three factors:

    1. Tumor Size: The size of the primary breast tumor (in centimeters).

    2. Lymph Node Involvement: The number of cancerous lymph nodes found in the patient's axilla (armpit).

    3. Tumor Grade: This reflects how abnormal the cancer cells look under a microscope and how quickly they are growing. Tumor grade is typically scored from 1 to 3, with 1 being the least aggressive and 3 being the most aggressive.

  • Formula: The Nottingham Prognostic Index (NPI) is calculated using the following formula:

    NPI = 0.2 * Tumor Size (cm) + Nodal Stage (1, 2, or 3) + Tumor Grade (1, 2, or 3)
    • Nodal Stage: This is a simplified version of the lymph node involvement, typically categorized as:
      • 1 = No involved lymph nodes
      • 2 = 1-3 involved lymph nodes
      • 3 = 4 or more involved lymph nodes

  • Interpretation: The resulting NPI score is then used to categorize patients into prognostic groups. Generally, lower scores indicate a better prognosis (longer survival), and higher scores indicate a poorer prognosis. While cut-offs can vary slightly depending on the study, typical groupings are:

    • Good Prognostic Group: Lower NPI scores (e.g., less than 3.4)
    • Moderate Prognostic Group: Intermediate NPI scores (e.g., 3.4 to 5.4)
    • Poor Prognostic Group: Higher NPI scores (e.g., greater than 5.4)

  • Importance: The NPI remains a valuable tool, although modern breast cancer management often incorporates additional factors, such as hormone receptor status (ER, PR) and HER2 status, to refine prognosis and guide treatment decisions. It provides a relatively simple and readily available means of assessing risk.

In summary, the Nottingham Prognostic Index (NPI) is a prognostics measure calculated from tumor size, lymph node involvement, and tumor grade used to predict the survival rate of operable primary breast cancer.

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