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{{Breast cancer staging}}
{{Evaluation of tumors}}
=== Grading ===The '''Nottingham system'''<ref>{{cite journal |last1= Elston |first1= CW |last2= Ellis |first2= IO |title= Pathologic prognostic factors in breast cancer. I. The value of histological grades in breast cancer. Experience from a large study with long-term follow-up |journal= Histopathology |year= 1991 |volume= 19 |issue= 5 |pages= 403–10 |pmid= 1757079 |doi=10.1111/j.1365-2559.1991.tb00229.x}} {{cite journal |title= Republished |year= 2002 |doi= 10.1046/j.1365-2559.2002.14892.x | volume=41 |journal=Histopathology |pages=154–161}}</ref> is recommended for breast cancer grading.<ref>{{cite web|title=What is the Nottingham combined histologic grade (modified Scarff-Bloom-Richardson grade) system for breast tumors?|url=https://www.medscape.com/answers/1668113-181367/what-is-the-nottingham-combined-histologic-grade-modified-scarff-bloom-richardson-grade-system-for-breast-tumors|author=Oudai Hassan|website=Medscape}} Updated: Mar 20, 2019</ref> The Nottingham system is also called the Bloom–Richardson–Elston system ('''BRE''')<ref>{{cite journal | last1= Al-Kuraya| first1= Khawla| last2=Schraml | first2=Peter |display-authors=et al | title= Prognostic relevance of gene amplifications and coamplifications in breast cancer | journal=Cancer Research| volume=64 | issue=23 | year=2004| pages= 8534–8540}}</ref>, or the Elston-Ellis modification<ref>Elston CW, Ellis IO. Pathologic prognostic factors in breast cancer. I. The value of histological grades in breast cancer. Experience from a large study with long-term follow-up. Histopathology 1991, 19:403-410.</ref> of the Scarff-Bloom-Richardson grading system.<ref name="BloomRichardson1957">{{Grading Cite journal | last1 = Bloom | first1 = H.J. | last2 = Richardson | first2 = W.W. | title = Histological grading and prognosis in breast cancer; A study of 1409 cases of which 359 have been followed for 15 years | journal = British Journal of Cancer | volume = 11 | issue = 3 | pages = 359–77 | year = 1957 | pmid = 13499785 | pmc = 2073885 | doi=10.1038/bjc.1957.43}}</ref><ref name="Genestie1998">{{Cite journal | last1 = Genestie | first1 = C. | last2 = Zafrani | first2 = B. | last3 = Asselain | first3 = B. | last4 = Fourquet | first4 = A. | last5 = Rozan | first5 = S. | last6 = Validire | first6 = P. | last7 = Vincent-Salomon | first7 = A. | last8 = Sastre-Garau | first8 = X. | title = Comparison of the prognostic value of Scarff-Bloom-Richardson and Nottingham histological grades in a series of 825 cases of breast cancer: Major importance of the mitotic count as a component of both grading systems | journal = Anticancer Research | volume = 18 | issue = 1B | pages = 571–6 | year = 1998 | pmid = 9568179}}</ref> It grades breast carcinomas by adding up scores for tubule formation, nuclear pleomorphism, and mitotic count, each of which is given 1 to 3 points. The scores for each of these three criteria are then added together to give an overall final score and corresponding grade as follows.{|class="wikitable"|==== Tubule formation ====By definition, tubule formation in classic invasive lobular carcinoma is scored as 3.<ref>{{cite web|url=http://surgpathcriteria.stanford.edu/breast/inflobcabr/grading.html|title=Infiltrating Lobular Carcinoma of the Breast|website=Stanford Medicine|accessdate=2021-01-06}}</ref> ==== Nuclear pleomorphism ====Such as nuclei being larger, darker, or irregular/pleomorphic.Note: The cancer areas having cells with the greatest atypia should be evaluated.* 1 point: nuclei with minimal or mild variation in size and shape* 2 points: nuclei with moderate variation in size and shape* 3 points: nuclei with marked variation in size and shape ==== Mitotic count ====[[File:Mitosis appearances in breast cancer.jpg|thumb|Mitosis appearances in breast cancer]]Mitotic figures are counted only at the periphery of the tumor, and counting should begin in the most mitotically active areas.* 1 point: Between 0-5 and 0-11 mitotic counts per 10 high-power fields (HPFs), depending on type of microscope used.<ref name=HPF group=notes>Mitotic count:* 1 point: 0-9 mitotic counts per 10 fields under X25 objective using the Leitz Ortholux microscope, 0-5 mitotic counts per 10 fields under X40 objective using the Nikon Labophot microscope, or 0-11 mitotic counts per 10 fields under X40 objective using the Leitz Daiplan microscope* 2 points: 10-19 mitotic counts per 10 fields under X25 objective using the Leitz Ortholux microscope, 6-10 mitotic counts per 10 fields under X40 objective using the Nikon Labophot microscope, or 12-22 mitotic counts per 10 fields under X40 objective using the Leitz Daiplan microscope* 3 points: Over 19 mitotic counts per 10 fields under X25 objective using the Leitz Ortholux microscope, over 10 mitotic counts per 10 fields under X40 objective using the Nikon Labophot microscope, or over 22 mitotic counts per 10 fields under X40 objective using the Leitz Daiplan microscope</ref>* 2 points: Between 6-10 and 12-22 mitotic counts per 10 HPFs.<ref name=HPF group=notes/>* 3 points: Over 10 to 22 mitotic counts per 10 HPFs.<ref name=HPF group=notes/> ==== Overall grade ====The scores for each of these three criteria are added together to give a final overall score and a corresponding grade as follows:* 3-5 '''Grade 1''' tumor ('''well-differentiated'''). Best prognosis.* 6-7 '''Grade 2''' tumor ('''moderately differentiated'''). Medium prognosis.* 8-9 '''Grade 3''' tumor ('''poorly differentiated'''). Worst prognosis.
{{Immunohistochemistry evaluation of breast cancer}}
{{Evaluation of tumors}}
{{Reporting of invasive breast cancer}}
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