Pathological diagnosis partitioned the samples into grade 1 ( n 93), grade 2 ( n 83), and grade 3 ( n 80). 4 References Nottingham system Nottingham is based on: Nuclear grade. Scores of 8 or 9 Only microinvasion present (not graded) No residual invasive carcinoma after. Histologic grade, as assessed by the Nottingham grading system, provides a strong predictor of outcome in patients with invasive breast cancer and should be incorporated in breast cancer staging systems. To ensure consistency, diagnosis of every specimen was made by a single, dedicated breast pathologist (JAH) from hemotoxylin and eosin (H&E) stained slides grade was assigned using the Nottingham Histologic Score 1, 2. Multivariate analyses showed that histologic grade is an independent predictor of both BCSS and DFS in operable breast cancer as a whole as well as in all studied subgroups. If they add up to 8 or 9, it means the cancer is grade 3 (poorly differentiated). If they add up to 6 or 7, it means the cancer is grade 2 (moderately differentiated). Differences in survival were also noted between different individual grades (1, 2, and 3). Histologic grade, Nottingham grade, or Elston grade If the numbers add up to 3 to 5, the cancer is grade 1 (well differentiated). ![]() ![]() Histologic grade is strongly associated with both breast cancer-specific survival (BCSS) and disease-free survival (DFS) in the whole series as well as in different subgroups based on tumor size (pT1a, pT1b, pT1c, and pT2) and LN stages (pN0 and pN1 and pN2). Each variable is given a score of 1, 2, or 3, and the scores are added to produce a grade. This study is based on a large and well-characterized consecutive series of operable breast cancer (2,219 cases), treated according to standard protocols in a single institution, with a long-term follow-up (median, 111 months) to assess the prognostic value of routine assessment of histologic grade using Nottingham histologic grading system. The Nottingham combined histologic grade evaluates the amount of tubule formation, the extent of nuclear pleomorphism, and the mitotic count (or mitotic rate). ![]() However, grade is not included in the recent revision of the TNM staging system of breast cancer as its value is questioned in certain settings. The three strongest prognostic determinants in operable breast cancer used in routine clinical practice are lymph node (LN) stage, primary tumor size, and histologic grade. Histologic grade is strongly associated with both breast cancer-specific survival (BCSS) and disease-free survival (DFS) in the whole series as well as in different subgroups based on tumor size (pT1a, pT1b, pT1c, and pT2) and LN stages (pN0 and pN1 and pN2).
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