Help Understanding my Grade

Monarchandthemilkweed

I was just recently diagnosed with IDC in March, surgery is May 11. The tumor is tiny. It's been measured as small as 5 mm and I've seen it measured at 8mm.

I understand grade is how aggressive the tumor is and mine is a grade 2. Here is the break down

The invasive carcinoma provisional Nottingham grade is 2

Tubular

Nuclei: 2

Mitosis: 1

How important are the three sepacomponents that make up the Grade?

SpecialK

These three aspects of grade reflect three components the pathologist sees when looking at your tumor or biopsy under the microscope. It is important to note that tumors are not homogenous in that different areas of a tumor can be different grades or even have different receptors. What the pathologist sees is a cross section, but hopefully a number of those from throughout the sample to reliably say what the grade is. In many instances the findings are corroborated by another pathologist before the report is signed off, so there is confirmation of what the first one is seeing. Grade demonstrates how close to, or how far away from, normal cells the tumor material appears. The tubular score shows how well the cells are trying to form normal looking glandular material. For a score of 1 in that category greater than 75% of the cells should form glands, for a 2 score 10-75%, for a 3 less than 10%. The more glandular formation the more the tissue resembles normal cells. For the nuclear category they are looking for small normal looking nuclei and uniformity so a score of 1 most closely resembles that, a score of 2 are larger than normal with less uniformity, for a 3 the variation is more marked. Mitosis reflects how rapidly the abnormal tumor cells are proliferating. A score of 1 is less than 7 mitoses on 10 high power fields, a score of 2 is 8-15 mitoses, a score of 3 is 16 or more mitoses. Since the added scores from each category could range from 3 (all 1 scores in each category) to 9 (all 3 scores) grade breaks down as such - Grade 1 is a total score from 3-5, Grade 2 is 6-7, and Grade is 8-9. So, your total score of 6 represents the low end of Grade 2, with the strongest aspect being tubule formation, and the weakest is proliferation. There is potentially some connection between mitoses and Ki67%, which is a marker for aggressiveness, but that comparison for me personally was discordant. I feel that oncologists look at grade generally as a whole and potentially less at the individual aspects, that Her2+ and triple negative tumors are often higher grade - often Grade 3, that strongly hormone positive tumors can be somewhat lower in grade but not always. The new TNM staging system used by some physicians does take grade into consideration. It uses tumor size, nodal status, metastatic status, grade, Her2 status, and ER/PR status in calculating stage. Previously stage was determined by tumor size, nodal and mets status. Hope this is helpful, your oncologist can explain how he/she views grade in formulating treatment decisions for you as an individual. Wishing you the best.

Beesie

Great explanation of grade from SpecialK.

My grade composition was the same as yours, although the nuclei was noted as being "1-2". The "2" was counted, so my total was 6. My oncologist looked at that and was pleased; he focused on the 6 total (lower half of grade 2) and specifically noted the low mitosis.

edj3

SpecialK, that helped me understand my own score, lo nearly two years later. Thank you!

SpecialK

Thanks Beesie!

I should also point out that sometimes grade can change from the biopsy sample to the surgically excised tumor - both if surgery is first, and if chemo is used before surgery. A surgically excised tumor provides the entirety to be sampled and grade is potentially more comprehensive rather than just a look at the biopsied area. In many cases the person performing the biopsy takes a number of cores from the tumor, in different areas, but this sometimes can be complicated by tumor position and biopsy method. Also, with chemo prior to surgery grade may be down-regulated by the effect of the chemotherapeutic agents.

Monarchandthemilkweed

Thank you ladies, that was very helpful explanation. I'm trying to lean as much as I can. This waiting period as you all know is so hard. I'm just worried about how much this thing is growing or changing.

SpecialK

edj3 - I'm so glad that was helpful - grade is a complex thing. We are given a grade often at the same time as hormonal receptor and Her2 info and without much explanation about what it means. At some point after diagnosis and during treatment I felt the need to understand it better, so I did some research.

monarch - the learning curve is steep, but we are all here to help you and offer support! Try not to worry, but I know that is easier said than done. If you look at other members signature lines you will see that many of us had a lag between diagnosis and surgery or other treatment, I definitely did as I was trying to line up both surgeons and their scheduling. I had another significant delay proceeding to chemo, it is more common than you would think for sure. I know there are some ER+ members who had delayed surgery due to Covid precautions last year and they started anti-hormonals as a means of some systemic treatment during the delay - that could be an avenue for you - might be worth asking the question.

GreyhoundMom2

Hi SpecialK,

Thanks for sharing your research! I was diagnosed with 4mmIDC Grade 3, non ER, PR Her-2 on 5/13/21. I have a consult scheduled on 5/25. I'm anxious to learn my options and prognosis.

Moderators

Welcome, GreyhoundMom2. We're so sorry you find yourself here, but we hope this community can be a source of support for you. Please keep us posted on how your appointment goes!

The Mods

KIDI919

SpecialK: You said oncologists look at the grade generally... I found that true with my onco. I somewhere between a 2 and a 3 but he was like yes you are a 3 but I'm not worried about that. He didn't seem to think that grading was as important as all the rest of the---for lack of a better word labs, genetic tests etc. Thank you for the info.