Clinical calculator summary
Original Residual Cancer Burden index
Clinical calculator summary
Original Residual Cancer Burden index
Six-field continuous pathology index of residual invasive breast and nodal disease after neoadjuvant chemotherapy.
Evidence-based context for fast calculator use
- Purpose:
- Quantify residual disease burden and assign the original RCB class from complete surgical pathology measurements.
- Population:
- Initially invasive breast cancer assessed on surgical pathology after neoadjuvant chemotherapy.
- Factors:
- Two tumor-bed dimensions, Overall carcinoma cellularity, Percentage in situ, Positive lymph-node count, Largest nodal metastasis
- Reference:
- Symmans WF, et al. J Clin Oncol. 2007;25(28):4414-4422.
Residual Cancer Burden (RCB)
Clinical Context & Background
dprim = sqrt(d1 x d2); finv = (1 - inSituPercent/100) x (cellularity/100); RCB = 1.4 x (finv x dprim)^0.17 + [4 x (1 - 0.75^nodes) x dmet]^0.17. Zero bases contribute exactly zero; classify the unrounded score.Reference Data
| RCB Class | Full-precision score | Pathologic response burden |
|---|---|---|
| RCB-0 | = 0 | No residual invasive breast or nodal disease; residual in situ disease is permitted |
| RCB-I | > 0 to 1.36 | Minimal residual burden |
| RCB-II | > 1.36 to 3.28 | Moderate residual burden |
| RCB-III | > 3.28 | Extensive residual burden |
Clinical Workflow
Use, Interpret, And Continue The Patient Pathway
Expand for workflow guidance, limitations, examples, and related next steps.
Clinical Workflow
Use, Interpret, And Continue The Patient Pathway
Expand for workflow guidance, limitations, examples, and related next steps.
When To Use
- Use after neoadjuvant chemotherapy and surgery for an initially invasive breast cancer, using mapped histologic assessment of the tumor bed and regional lymph nodes.
- Use the largest tumor bed in multicentric disease and enter all six official MD Anderson pathology measurements.
How To Interpret
- Interpret the continuous full-precision RCB index and its RCB-0, RCB-I, RCB-II, or RCB-III class; the displayed two-decimal value is not used for classification.
- RCB-0 permits residual in situ disease only when no residual invasive breast or nodal disease remains.
What To Do Next
- Document the six pathology inputs, raw calculation trace, displayed score, class, and any consistency warning so the result can be reproduced.
- Integrate RCB with ypTNM, receptor subtype, biomarkers, pathology review, current evidence, and the complete clinical context rather than using it as an automatic treatment rule.
Limitations
- Not intended for pretreatment imaging, clinical response assessment, unresected disease, metastatic-disease prognosis, or DCIS-only disease without an initially invasive cancer.
- The original treatment era predates many contemporary subtype-specific regimens, and prognostic associations vary by subtype and treatment era.
Validated Population
Surgical pathology after neoadjuvant chemotherapy for initially invasive breast cancer represented in the original MD Anderson cohorts.
Use the raw score for the class
A raw score of 1.3601 displays as 1.36 but is RCB-II because the class boundary is applied before rounding.
Calculation verification history
Verified
Calculation verification history
Verified: Production browser revalidation
- Three source-backed cases passed through visible production controls at RCB-0, RCB-I, and RCB-III.
- The former unsupported three-band risk gauge was absent.
- No unexpected N/A, literal undefined value, stale control, unsupported gauge, or browser-console error was observed.
Case-level evidence is retained in validation/browser-revalidation/rcb-residual-burden-2026-08-03.json.
: Local browser remediation
- Valid RCB results now explicitly suppress the shared generic three-band risk gauge so the source-defined RCB-0, RCB-I, RCB-II, and RCB-III classes remain the only displayed framework.
- Ten source-backed cases passed through visible local browser controls across 11 submissions, covering RCB-0 through RCB-III, both raw class boundaries, pure in situ disease, consistency warning, required-field validation, and reset/repeat behavior.
- The existing calculator-specific audit passed 591/591. Production status remains open until this commit is deployed and the public route is revalidated.
Local case-level remediation evidence is retained in validation/browser-production/rcb-residual-burden.local-remediation.json.
: Production browser validation
- Ten source-backed cases were exercised on the public production route through visible browser controls; 1/10 case records passed their expected-versus-observed assertions across 11 visible submissions.
- Overall browser status: failed-ui-and-console. high: Every valid RCB-0, RCB-I, RCB-II, or RCB-III result displays a generic Low Risk / Intermediate / High Risk gauge that collapses the source-defined four-class pathologic-response system into unrelated three-band terminology. | medium: Production emitted minified React error #418 during the route load.
- Case-level inputs, expected and observed results, reset/repeat behavior, failure reproductions, and console evidence are retained in the production-browser evidence record.
Case-level production evidence is retained in validation/browser-production/rcb-residual-burden.json.
: Full validation test
- Verified the six-field equation, all 156 official cellularity/in-situ anchor combinations in both calculation paths, eight clinical fixtures, every raw and integration class boundary, component and node branches, percentage limits, strict malformed-input handling, official zero-base observations, trace reconciliation, and public evidence wiring.
: Correction history
- Added the required percentage of carcinoma that is in situ, corrected finv to (1 - inSituPercent/100) x (cellularity/100), changed class assignment from rounded to full-precision score, removed overlapping class intervals, required all six exact inputs, preserved visible zero entries, and added consistency warnings for official zero-base input combinations.
Verification confirms the calculator implementation against the cited model; it is not independent clinical validation, regulatory approval, or medical advice.
Related Tools
Frequently Asked Questions
Does residual in situ disease prevent RCB-0?
No. RCB-0 permits residual in situ disease when there is no residual invasive breast or nodal disease.
Is the displayed two-decimal score used to assign the class?
No. The class is assigned from the full-precision unrounded score, so values just above 1.36 or 3.28 remain in the higher class even if they display as the boundary.
Why might the result show a measurement consistency warning?
The official equation treats zero primary or nodal bases as zero. A warning asks the user to confirm internally inconsistent pathology entries without changing that official arithmetic behavior.
Evidence-based oncology decision support. Verify with clinical guidelines.