pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long‐term follow‐up

TLDR

Morphological assessment of differentiation provides prognostic information in breast cancer, yet histological grading was not routinely used due to reproducibility concerns, though it is now a component of the Nottingham prognostic index for patient stratification. The Nottingham/Tenovus study modified the Bloom & Richardson grading system into a semiquantitative method scoring tubule formation, nuclear pleomorphism, and mitotic count, then summing these to assign one of three grades, and applied it to over 2200 operable breast cancer patients. In 1831 patients, histological grade strongly predicted survival, with grade I tumors showing significantly better outcomes than grades II and III, confirming the method’s prognostic value and reproducibility.

Abstract

Morphological assessment of the degree of differentiation has been shown in numerous studies to provide useful prognostic information in breast cancer, but until recently histological grading has not been accepted as a routine procedur mainly because of perceived problems with reproducibility and consistency. In the Nottingham/Tenovus Primary Breast Cancer Study the most commonly used method, described by Bloom & Richardson, has been modified in order to make the criteria more objective. The revised technique involves semiquantitative evaluation of three morphological features–the percentage of tubule formation, the degree of nuclear pleomorphism and an accurate mitotic count using a defined field area. A numerical scoring system is used and the overall grade is derived from a summation of individual scores for the three variables; three grades of differentiation are used. Since 1973, over 2200 patients with primary operable breast cancer have been entered into a study of multiple prognostic factors. Histological grade, assessed in 1831 patients, shows a very strong correlation with prognosis; patients with grade I tumours have a significantly better survival than those with grade II and III tumours (P<0.0001). These results demonstrate that this method for histological grading provides important prognostic information and, if the grading protocol is followed consistently, reproducible results can be obtained. Histological grade forms part of the multifactorial Nottingham prognostic index, together with tumour size and lymph node stage, which is used to stratify individual patients for appropriate therapy.