A 55-year-old postmenopausal woman has a breast mass. Core biopsy shows infiltrating carcinoma with tubule formation in >75% of the tumor, mild nuclear pleomorphism, and <5 mitoses/10 HPF. Nottingham grading would assign this tumor a grade of:

• A Grade 2 (moderately differentiated) — score 5-6
• B Grade 3 (poorly differentiated) — score 8-9
• C Grade 2 — score 7
• D Grade 1 (well differentiated) — score 3 ✓

Explanation

The Nottingham grading system (Elston-Ellis modification of Scarff-Bloom-Richardson) scores three parameters, each 1-3: (1) Tubule formation: >75% = 1 point; (2) Nuclear pleomorphism: mild/uniform = 1 point; (3) Mitotic count: <5/10 HPF (depending on microscope field) = 1 point. Total score = 3 = Grade 1 (well differentiated, favorable prognosis). Score 4-5 = Grade 1; score 6-7 = Grade 2; score 8-9 = Grade 3. Grade 1 has 5-year recurrence ~5%, while Grade 3 has >50% recurrence risk.

Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.