Mitosis and grade

bluepearl

My reports from three different agencies, said I have 6 mitosis per 10 field something or other. There was disagreement on either grade 2 or grade 3, bit because there were two reports that said grade 3, I accepted that. However, seems to me that a 6 would be grade 2???? Any ideas?

Anonymous

I have lost my reports about tumor grade. But I recall that it is a two step process. Firstly, three different items are individually graded from 1 to 3. 

degree of tumor tubule formation (percentage of cancer composed of tubular structures)tumor mitotic activity (rate of cell division)nuclear grade (cell size and uniformity)

 

These three numbers are added together (for a total of 3-9), then averaged by dividing by 3, which is how we end up with overall grades of 1-3. In my case, I had a 1, 2, and 3.   So my total of 6 divided by 3 did give me a grade 2 tumor.

 

When you mention "6 mitosis per 10 field...," I think that is referring to the step where each individual item is graded.  Here is an excerpt from an external post.  Looking at this, a "6" would grade this section as a ONE. But I don't know how, even if the other two areas were both 3s, you would end up with a 3 overall. Because that would make your total a 7, and that averages out to a grade 2 (I think only 8 and 9 totals are converted/averaged out as 3). 

Using the Nottingham combined histologic grade for invasive breast carcinomas, one factor that goes into the scoring range of 3 to 9 (9 being the worst) is mitotic count per high power field.
Something like 
< 10 mitoses per 10 HPF gets a 1
10-20 mitoses per 10 HPF gets a 2
> 20 mitoses per HPF gets a 3

Did I confuse the issue even more?

Timbuktu

My bc had a mitosis of 1 but a grade of 2.  I could not understand how chemo could work on a slowly dividing cell.  The dr said even slowly dividing cancers grow more quickly than any other cell.

Anonymous

Timbuktu:

If I remember correctly, that is the reasoning behind getting chemo spread out over time--so that the cells are targeted when they are dividing, whenever that happens to be.  Then again, I'm not an oncologist, it's just what I remember from my office visits.  Wow, I think my memory is finally coming back-9 years after treatment.  Heehee.

bluepearl

Where ever I read about 6 per 10 field it comes out as a stage 1 mitosis. I am thinking, perhaps, it may have been a grey area so they put it to a 2 so then I ended up with 8/9 grade 3 instead of grade 2. I'd have preferred the 1. In any case, I still didn't get chemo because of the small size, my age (63), and favorable profile. On tamoxifen for now, next year an A.I. Thank you for responding.