Nottingham grading system

Nottingham grading system

A modification of the Bloom-Richardson system for histologically stratifying usual-type (ductal) breast carcinoma into prognostic groups. Each of 3 features (gland formation, nuclear atypia/pleomorphism and mitotic activity) is assigned a score between 1 and 3, then added together to provide a score between 3 to 9.

Nottingham grading system
Gland (acinus) formation
Score 1: > 75% of the whole carcinoma forms acini.
Score 2: 10–75% of the whole carcinoma forms acini.
Score 3: < 10% of the whole carcinoma forms acini.

Nuclear atypia/pleomorphism
Only score clearly formed glandular lumens surrounded by polarised cancer cells. Only about 5% of symptomatic cancers score 1 for nuclear atypia; about 50% score 3.

Score 1: Nuclei only slightly larger than benign breast epithelium (< 1.5 X normal area); minor variation in size, shape and chromatin pattern.
Score 2: Nuclei distinctly enlarged (1.5–2 X normal area (1)), often vesicular, nucleoli visible; may be distinctly variable in size and shape but not always.
Score 3: Markedly enlarged vesicular nuclei (> 2 X normal area (1)), nucleoli often prominent; generally marked variation in size and shape but atypia not necessarily extreme.

Mitotic count
Score 1: ≤  4/10 hpfs, each measuring 0.4 mm2.
Score 2: 4–10/10 hpfs, each measuring 0.4 mm2.
Score 3: ≥ 10/10 hpfs, each measuring 0.4 mm2.

Score Differentiation Prognosis
1: 3–5—Well-differentiated–Best
2: 6–7—Moderate–Intermediate
3: 8–9—Poor–Worst
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References in periodicals archive ?
To overcome these limitations, some additional quantitative parameters can be tentatively suggested, including the number of mitoses (as in the Nottingham grading system for breast cancer), (20) nuclear size and shape (as in the Fuhrman grading system for renal cell carcinoma), (19) the diameter of the microscopic field, and the number of fields to be evaluated.
In 133 cases the slide from the block sent for Oncotype DX analysis was reviewed by 1 pathologist and a nuclear grade, tubule score, and mitotic count score were determined with the Nottingham grading system. (7) In 5 cases the slides were not available for review.
We found that in all cases with both a negative progesterone receptor result, as determined via immunohistochemistry, and a mitotic count score of 3 with Nottingham grading system, (7) the Recurrence Score was high.
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