I    Pathology

Tiffany M. Graham, M.D.

INFOR
     A FOCAL SOURCE OF PATHOLOGY INFLAMMATION

Breast Cancer Grading

Modified Bloom-Richardson Grading System

How it works:
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Point-Scoring System
The tumor should be graded based on the representative portion of tumor (not the least differentiated part). Three factors are
assessed when determining the grade:

1. Tubule formation: How much of the tumor tissue has normal breast (milk) duct structures. 
Tubules must have clear central lumina to be counted
2. Nuclear grade: An evaluation of the size and shape of the nucleus in the tumor cells. 
Evaluate the “ugliest” area of tumor for nuclear pleomorphism
3. Mitotic rate: How many dividing cells are present, which is a measure of how fast the tumor cells are growing and
dividing. 
Assess mitotic count in the most active part of the tumor.
You should count at periphery of tumor.
Need to assess 10 high powered fields, but they don’t have to have 10 contiguous fields
Overall Tumor Grade
Summary
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