Several schemes have been proposed for grading breast carcinomas. These generally include architectural cellular arrangement, nuclear features, and other items such as mitotic rate. The Surveillance, Epidemiology, and End Results (SEER) data from thousands of patients have shown that breast tumor grading, irrespective of the scheme used, has prognostic signifi-cance.36,37 The 1990 Consensus Conference recommendation—that nuclear grade be evaluated—has now been largely superseded by increasing consensus that a single classification scheme should be adopted. The Elston scheme, which includes nuclear and architectural features and mitotic count, is increasingly used.38,39 Consensus on a preferred grading scheme is likely to be forthcoming.40-44 Nuclear grading is also possible on cytology preparations from touch imprint or fine-needle aspiration. Athough not equivalent to the combined architectural/cyto-logic systems used in surgical pathology, it may provide important data on nuclear grade.9-11 Clearly, patients with low-grade (better-differentiated) breast cancers have a better prognosis than those with high-grade (poorly differentiated) carcinoma. The reader is referred to Chapters 5 and 6 for a detailed discussion on breast pathology.
Was this article helpful?