Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
Pathology Associates Of Lexington, P.A.
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        The Cummings Prognostic Index
      

[Back to Breast Cancer Index]

This is a prognostic index for breast cancer cases with node negativity or occult node positivity. Reported in American J. of Surg. Path. 26(10):1286-1295, 2000, this index requires three factors: details of node status (to include size of metastatic deposits) and tumor grade. They went back to 203 (1971-1989) cases of originally node-negative (by simple study) cases and processed the saved blocks with stepcuts and IHC and found that 25% were actually node positive. This Queensland group of surgically-treated cases has 10 year follow-up information. This index disregards tumor size and type.

CMI:

  • grade: use the Ellis-Elston modification of the S-B-R system to assign the grade.

  • metastasis analysis: 

    • use complete node processing with combination of stepcut H&Es and IHC.

    • precisely measure the size of the largest metastasis and define it as greater or less than 0.5 mm in greatest diameter

Calculate the CMI:

  • grade: 1=1 point; 2=2 points; 3=3points

  • lymph node status:

    • negative nodes= 1 point

    • largest metastasis is less than 0.5 mm= 2 points

    • largest metastasis is greater than 0.5 mm=3 points

  • now sum the 3: ______________

Survival data as it might impact chemotherapy decisions:

  1. CMI of 2= 95-100% 10 year disease free and overall survival. May not need cytotoxic chemo.?

  2. CMI of 3= 80% 10 year disease free and 87% 10 year overall survival

  3. CMI of 6= 50% recurrence in less than 3 years & 55% overall survive 10 years.

(posted 18 January 2003)
 
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