A pathology report describes a breast carcinoma as histologic grade 2 and assigns the stage pT2N1M0. Which statement correctly distinguishes grading from staging?

• A Grading reflects tumor size and nodal spread while staging reflects cytologic atypia
• B Grading is based on degree of differentiation and mitotic count while staging is based on extent of spread ✓
• C Grading uses the TNM system while staging uses the Bloom-Richardson score
• D Both terms describe the same feature and are used interchangeably

Explanation

Grading assesses how closely the tumor resembles its tissue of origin, incorporating architectural differentiation, nuclear pleomorphism, and mitotic count, exemplified by the Nottingham score for breast carcinoma. Staging, using the AJCC TNM system, measures the anatomic extent of disease through tumor size, nodal involvement, and distant metastasis. Option A reverses the two concepts, and option C swaps the systems, both being common student errors that this item exploits.

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

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