Breast malignant, males, children
Breast cancer
Histologic grading

Author: Monika Roychowdhury, M.D. (see Authors page)

Revised: 20 October 2016, last major update January 2012

Copyright: (c) 2002-2016, PathologyOutlines.com, Inc.

PubMed Search: Histologic grading [title] breast

Cite this page: Histologic grading. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/breastmalignanthistologic.html. Accessed December 4th, 2016.
Definition / General

Tumor tubule formation:
  • 1 point: > 75% of tumor
  • 2 points: 10 - 75% of tumor
  • 3 points: < 10% of tumor

Note: the overall appearance of the tumor must be taken into consideration in scoring tubule formation
Note: tubules must have clear central lumina to be counted

Number of mitotic figures in most active area, counting 10 high power fields:

(a) (b) (c)
1 point: 0 - 5 0 - 9 0 - 11
2 points: 6 - 11 10 - 19 12 - 22
3 points: 11+ 20+ 23+

(a) Nikon or Labophot 40x objective or comparable with field diameter of 0.44 mm
(b) Leitz or Ortholux 25x objective or comparable with field diameter of 0.59 mm
(c) Leitz or Diaplan 40x objective or comparable with field diameter of 0.63 mm

Notes:
  • Count mitotic figures at periphery of tumor in most mitotically active area; count 10 high power fields in the same area, but not necessarily contiguous; select fields with as much tumor as possible; avoid poorly preserved areas; ignore cells with hyperchromatic and pyknotic nuclei, which may be undergoing apoptosis
  • Quick scan mitotic impression is less accurate (Hum Pathol 2008;39:584)

Nuclear pleomorphism:
  • 1 point: minimal nuclear variation in size and shape; small regular uniform cells
  • 2 points: moderate nuclear variation in size and shape
  • 3 points: marked nuclear variation in size and shape

  • Note: evaluate areas with greatest atypia
  • Note: for infiltrating lobular carcinoma, two tiered grading system for nuclear pleomorphism is recommended (Ann Diagn Pathol 2009;13:223)

Scoring
  • 3 - 5 points: well differentiated (grade I)
  • 6 - 7 points; moderately differentiated (grade II)
  • 8 - 9 points: poorly differentiated (grade III)

Criticisms of Nottingham Bloom Richardson grading system
Clinical Features
Micro Images

Images hosted on PathOut servers:

Tubule formation (AFIP Fascicle Third Series)
Left: 1 point (> 75% tubules)
Right: 3 points (< 10% tubules)



Images hosted on other servers:

Nuclear pleomorphism: mild (left), moderate (center), marked (right)

Overall histologic grades - Low grade

Overall histologic grades - Possibly high grade



Overall histologic grades - High grade

High grade