Significance of the 3 factors that form our Grade level

LittleMelons

I know there are a lot of knowledgeable people out there and was wondering if you know what the significance of the three factors that constitute the Grade - 1,2 or 3.  For example, my pathology reports states that I am Grade 2 with: Tubule formation = score 3; Nuclear Pleomorphism = Score 3; mitotic count = score 1. This looks like a high grade 2 to me. Wouldn't that mean it is fairly aggressive? Which of these scores is most significant in terms of prognosis?  Thanks for any input you can give.

kathleen1966

I had the same three scores as you have.  It is considered high grade II, meaning right on the edge of grade II/III (Though technically grade II, not sure why they come up with these grades then).  I have read that your mitonic rate alone can predict prognosis.  And a lower score is better, this tells how fast the cancer is growing.  Though being also Her2+ I'm not sure what a low mitonic rate actually means for me. But I liked reading this!

Anonymous

Hello, did you check BCO's "how to interpret your biopsy report".  Lots of valuable info there.  From my experience, very very few doctors will qualify a tumour "agressive".  I asked my onco whether mine was agressive, as I had figured my tumours must be, and he refused to tell me, saying "we don't know", his favourite answer....

dlb823

Since it takes all 3 of those components to differentiate breast cancer cells from normal cells, and since each is weighted 1 to 3, it seems like they would all be equal in importance.

However, the Nottingham grade only tells us the degree of aggressiveness.  I don't think it in any way tells prognosis unless a woman didn't get treatment, in which case a Grade 3 would grow faster than a Grade 1 or 2.  So I don't think you can say any one part of the Nottingham scale is any more important than another, but that's just the way I see it.

I also think as we move through this bc experience, we tend to go back and reread our pathology report each time we learn something new, looking for signs or assurances re. the future -- at least I did.  But eventually that passes, and you learn not to worry so much about something that is probably largely beyond our control post-tx, assuming we've done what was recommended and are doing all the healthy things over which we have some control now.   Deanna

LittleMelons

I did look at the BCO information on pathology reports, but didn't see an explanation of the three factors in the Grade, unless I overlooked something.  I guess I am intrigued, because the scores seem somewhat contradictory.  I did look it up in Susan Love's book.  She says nuclear grade shows "how abnormal the DNA is", so mine at 3 is the worst.  "Well-formed tubules are better than poorly formed ones" - mine at 3 are the poorest. But the mitotic rate of 1 means the cells are dividing slowly.  So it seems that the worst kind of cells are dividing slowly.

 But it could work the other way, where you have less abnormal and better formed cancer cells dividing quickly.  How would that change the prognosis, I wonder.  I have pretty much accepted that "it is what it is", do the prescribed treatments, and try to get on with life, but sometimes I get caught up in thinking about what is happening in there and want to understand it better.

kira1234

LittleMelons, Good question. My guess and it is a guess is no matter how the numbers come up the total decides your grade.

edwards750

LittleMelons...The way I understand it the Pathologist decides the grade level of the tumor. If the cancer cells are most like normal cells it is Grade l. Grade 2 is intermediate and Grade 3 is the most aggressive and looks least like normal cells.

SpringFever2011

I wonder....and wonder ..lol.... About the subjective nature of GRADE. .....

LittleMelons

SpringFever2011 - You are absolutely right to wonder. ..lol...Even Susan Love wonders.  In talking about the grade scoring she says "Grade 3 is the highest and supposedly the most aggressive.  Unfortunately all of these features are very subjective.  A comparison of different pathologists'  Nottingham/Bloom Richardson scores...showed they agreed only 75% of the time."

I wonder about the subjectivity of other tests as well. 

I'm thinking maybe it would be better to stop wondering and have a glass of wine...lol.