Changes

=== 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">{{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.

==== Tubule formation ====

{{#ifeq: {{{lobular}}} |yes|By definition, 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>|[[File:Tubule formation score in the Nottingham system.jpg|thumb|500px|Tubule formation score in the Nottingham system]]