Nottingham grading system

(redirected from modified Bloom-Richardson-Elston 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.

Grade 
Score Differentiation Prognosis
1: 3–5—Well-differentiated–Best
2: 6–7—Moderate–Intermediate
3: 8–9—Poor–Worst
Full browser ?