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| =Grading breast cancer= | | =Grading breast cancer= |
| Most common system: ''Nottingham'' (aka Scarff-Bloom-Richardson) which is based on:
| | {{Main|Breast cancer grading}} |
| #Nuclear grade.
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| #*Small, regular (1.5-2x RBC dia.) = 1.
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| #*Moderated variability = 2.
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| #*Marked variation (>2.5x RBC dia.) = 3.
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| # Tubule formation.
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| #*Majority of tumour - tubules >75% = 1.
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| #*Moderate - 10% to 75% = 2.
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| #*Minimal <10% = 3.
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| # Mitotic rate.
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| #*0-5 mitosis/10 [[HPF]] (1.52 mm^2 --or-- 0.0152 mm^2 * 10) = 1.
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| #*6-10 mitosis/10 HPF (1.52 mm^2) = 2.
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| #*>11 mitosis/10 HPF (1.52 mm^2) = 3.
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| Mnemonic: ''TMN'' = tubule formation, mitotic rate, nuclear grade.
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| Notes:
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| *Elston & Ellis devised the system that is used.<ref name=pmid12405945>{{cite journal |author=Elston CW, Ellis IO |title=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. C. W. Elston & I. O. Ellis. Histopathology 1991; 19; 403-410 |journal=Histopathology |volume=41 |issue=3A |pages=151–2, discussion 152–3 |year=2002 |month=September |pmid=12405945 |doi= |url=}}</ref> They also wrote a follow-up article in 2002.<ref name=pmid1757079>{{cite journal |author=Elston CW, Ellis IO |title=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 |journal=Histopathology |volume=19 |issue=5 |pages=403–10 |year=1991 |month=November |pmid=1757079 |doi= |url=}}</ref>
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| ==Note about mitosis counting==
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| *One MUST adjust for the size of the field of view.
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| *Most of the Resident scopes have an eye piece diameter of 22 mm. Therefore, the field diameter at 40 X is approximately 22 mm / 40 X ~= 0.55 mm and the field of view is pi/4*(0.55 mm)^2 = 0.2376 mm^2.
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| **Thus, on a resident scope (with a FOV of 0.2376 mm^2) one should sample 6 or 7 fields of view (FsOV).
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| ***Calculation: 1.52 mm^2 (sampling area) / 0.2376 mm^2 (area / FOV ) = 6.40 FsOV.
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| *'''RANT''': Sampling 10 fields, where the field of view (FOV) is 0.152 mm^2, is ''not'' the same as sampling ten fields, where the FOV is 0.312 mm^2. It surprises me that Elston & Ellis ignore the fact that "10 HPFs" on different microscopes represent different sample areas and that they do ''not'' standardize the sampling area.
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| ==Calculating Nottingham score==
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| *Grade I = 3-5 points.
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| *Grade II = 6-7 points.
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| *Grade III = 8-9 points.
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| Notes:
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| *I've found most tumours are grade II.
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| *The mitotic score is usually 1/3.
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| *The nuclear score is rarely 1/3 -- even in the tubular subtype.<ref>MUA. 20 January 2009.</ref>
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| =Staging breast cancer= | | =Staging breast cancer= |