A pathologist reports a breast carcinoma as 'poorly differentiated, Nottingham grade 3'. The patient has a 2 cm tumour with two involved axillary nodes and no distant metastasis. Which statement correctly distinguishes these two descriptors?

• A Grade describes tumour extent and stage describes cellular differentiation
• B Grade describes cellular differentiation and stage describes anatomical extent of disease ✓
• C Both grade and stage describe anatomical extent but use different systems
• D Stage is determined by the pathologist while grade is determined clinically

Explanation

Grade reflects how closely the tumour resembles normal tissue and is based on differentiation, tubule formation, nuclear pleomorphism and mitotic count. Stage summarises anatomical extent using the TNM elements: tumour size, nodal status and metastasis. The two are independent prognostic variables; a high-grade tumour can still be low stage, and confusing the terms is a classic examination trap.

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

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