Breast cancer grading

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Grading for breast cancer.

Scarff-Bloom-Richardson Grading

Also known as the Scarff-Bloom-Richardson grading. Originally described in 1957 and based mainly on architecture.[1]

The grading as used in the Nottingham prognostic index is sometimes referred to as the Nottingham modification of the Bloom-Richardson system or Nottingham grade. Other synonyms include Elston grade or Elston-Ellis modification.

The NHS Breast Screening Programme web-site have a reference card with representative photomicrographs as a guide to scoring.[2]

Modified Bloom-Richardson grading
Feature Points Description
Tubule formation 1 point Tubular formation in >75% of the tumour
2 points Tubular formation in 10-75% of the tumour
3 points Tubular formation in <10% of the tumour
Nuclear pleomorphism 1 point Nuclei with minimal 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 1 point Low
(varies with size of hpf[2]) 2 points Medium
3 points High
Total 3-5 Low (Grade I)
6-7 Intermediate (Grade II)
8-9 High (Grade III)