• By variety³:
  • classical: prognostic behavior [by stage] is somewhere between IDC NOS and tubular carcinoma³...44% having systemic recurrences⁵ 
  • 12 year actuarial survival of 100% if tubulolobular variant;  13% have systemic recurrences⁵
  • solid & pleomorphic are the worst lobulars...40-57% systemic recurrences⁵
• By Bloom-Richardson nuclear criteria:
  • tumor nuclei have diffuse chromatin, absent/inapparent nucleoli and average no larger than 1 to 1.5 RBC diameters:
    nuclear grade 1 (one point)
  • tumor nuclei have coarse chromatin, present but infrequent nucleoli and average no larger than 1.5 to 2.0 RBC diameters:
    nuclear grade 2 (two points)
  • tumor nuclei have vesicular chromatin, frequent nucleoli and average larger than two RBC diameters:
    nuclear grade 3 (three points)
• By the Elston combined nuclear & histologic system¹:
  • lobular grades fairly well by this system ⁴
  • most lobulars are grade II²
  • grading:
    • TUBULES: (a pattern or architectural parameter assessing cellular organization...the tumor's ability to maintain some semblance of normal order...how bad the tissue organization looks)
      1. 1 point, if lots of tubule formation (greater than 75% "tubularity"/"glandularity")
      2. 2 points, if moderate " " (10-74% " " )
      3. 3 points, if sparse to no " " ( 0-9% " " )
    • NUCLEAR [size/shape] VARIATION: (a cytological/cellular parameter...how bad the cells look)
      1. 1 point, if only mild nuclear enlargement, no/mild darkening of chromatin [nuclear DNA/chromosomes], no/mild variation of nuclear shapes and sizes.
      2. 2 points, if moderate such changes.
      3. 3 points, if nuclei quite large, or bizarre, or have prominent nucleoli, and are quite dark [hyperchromatic]
    • MITOTIC ACTIVITY: (a growth-rate parameter which is determined in the tumor area showing the fastest growth rate, usually the tumor periphery, counting the number of mitotic figures in ten high-power microscopic fields [hpf]...ours is with a 40x objective)
      1. 1 point, 0-9 mitotic figures in ten high-power fields.
      2. 2 points, 10-19 " " " " "
      3. 3 points, 20 or more " " " "

1. Elston ref.
2. Tavasolli ASCP May 1995
3. Interdisciplinary Conference 2 vol. manuals, 9/2000 Palm Springs, Calif., Lazlo Tabar seminar
4. Tavasolli text
5. Rosen text

(posted 5 June 2002)