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
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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 procedure, 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 less than 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.