What is the grade of my tumor?

I beleive that a score of 4 is Grade 1.

Mindy this is what I found:

The Nottingham histologic score is simply a scoring system to assess the "grade" of breast cancers.

It is a total score based on 3 different sub-scores. The 3 sub-scores are assigned based on 3 components of how the breast cancer cells look under a microscope. (The details of these 3 components are not critical for you to understand). Each of the 3 components is assigned a sub-score of 1, 2, or 3, with 1 being best and 3 being worst. Once the 3 sub-scores are added, a Nottingham score is obtained: the minimum score possible is 3 (1+1+1) and the maximum possible is 9 (3+3+3).

A histologic grade of III is assigned to any patient with a Nottingham score of 8 or 9. Grade I refers to Nottingham scores of 3, 4, and 5, while Grade II refers to Nottingham scores of 6 and 7.

In the end, the Nottingham score and histologic grades are not very useful in the big picture, as they do not alter final overall treatment recommendations. High-score cancers tend to relapse more often than low-score cancers. Ultimately, however, we don't use the score in making clinical decisions.

Taken from Adjuvant! Online - which we patients are not supposed to see, except that there is no gatekeeper to stop us. This is part of a discussion that compares Adjuvant's prognostic values with that of other estimates/indices, and this part of the discussion involves the Nottingham index. It is mu understanding that Nottingham is calculating for without treatment, except surgery : 

  Comparison with the Nottingham Prognostic Index

A comparison of the projections made by Adjuvant! with the Nottingham prognostic index is of interest. The Nottingham Prognostic Index (NPI) was derived from a multivariate analysis of a series of patients seen in Nottingham who had operable breast cancer, who were not older than 70 years of age, who had primary tumors with a clinical size of less than 5 cm, and would had undergone a triple lymph node regional sampling. This nodal sampling was not a usual North American approach, but required biopsies of low axillary, apical axillary, and internal mammary nodes. A patient's lymph node score was 1 if tumor was absent from all nodes sampled, 2 if only low axillary nodes were positive, and 3 if apical and/or other nodes were positive (7,8).

The Nottingham Prognostic Index =

Tumor size in centimeters * 0.2 +
Stage of lymph nodes (1 to 3 by level ) +
Histologic grade (1-3: good, moderate, poor)

 Patients were broken out into subsets:

                                                        Index:                              15-year OS (overall survival)

Age-matched women                          ------                                                    83%

 Excellent Prognosis Group (EPG)      Equal to or less that 2.4                        87%

 Good Prognosis Group (GPG)           Less then 3.4                                       80%

 Moderate Prognosis Group (MPG)      3.4 - 5.4                                              42%

 Poor Prognosis Group (PPG)             More than 5.4                                      13%

(This makes my 15-OS prognosis "poor". I feel like saying something politically incorrect against myself but it might offend others so I will refrain)) 

 Converting this NPI into Breast Cancer Specific Survival (correcting for competing non-breast cancer mortality) converts the approximate expected survivals to > 95% for EPG, > 90% for the GPG, ~ 50% for the MPG, and < 25 % for the PPG.

There are some non-idealities of this index. One is that the type of axillary node dissection and staging is rather different than that usually done in many countries. One can however examine what the predicted outcomes will be for node negative patients.

(TWO TABLES FOLLOW, WHICH I WOULD HAVE TO COPY FROM SCRATCH. THEY ARE ABOUT NODE-NEGATIVE WOMEN AND DISCREPANCIES BETWEEN ADJUVANT! AND NOTTINGHAM)

 What can be seen in this analysis is that Adjuvant! is not as optimistic as the NPI about the outcome of patients with Grade 1 T2N0 tumors. Both methods suggest that Stage 1 Grade 1 cases have superb prognoses. In general Adjuvant! is more optimistic about patients with Grade 2 tumors, and also more optimistic for patients with Grade 3 tumors.

There are some very significant differences between Adjuvant! and the NPI. For example, for a very common subset of patients (those with 2 cm tumors,which are NN, with a histologic grade of 2) the NPI is 0.2 *2 + 1 + 2 = 3.4. This patient would be in the moderate risk NPI group with an NPI estimate of 10 year breast cancer related mortality of ~50%, while Adjuvant! and other sources such as FinProg give estimates of ~ 10%!

Thus Adjuvant! is in general more optimistic than the NPI. This may be based on a number of factors. First the projections for the NPI are for 15 years of follow-up rather than 10 years. Second, and possibly more importantly, the data base upon which the NPI is based on data from patients who only had axillary node sampling (requiring only as few as 3 nodes to be examined), rather than the more complete axillary dissections requiring at least 6 nodes used by Adjuvant!

If patients with < 90% long term survival are to be treated then users of the NPI would treat all Stage 1 patients with T1N0 Grade 3 tumors, patients with T1cN0 Grade 2 tumors, and patients with T2N0 tumors with Grade 2 and 3 disease. Users of Adjuvant! would treat only Stage 1 patients with the larger T1cN0 Grade 3 tumors, and all patients with T2N0 tumors irrespective of Grade.

My previous post ins't exactly a direct answer to winterstorm's question. I suppose I am amplifying things a bit. I hope this rest of you don't mind. This has been gnawing at me. The difficulty for us is that we are getting diagnosed and appraise according to apples and oranges all the time as though it were apples and apples. Nottingham is meant to grade, but not as a treatment decision-making tool, and the prognosis is 15 years out. It is working from different data that Adjuvant!, which uses SEER data (as does Lifemath) and only looks 10 years out and I believe is only intended to guess at your outcome based on treatment. 

 Mindy, the fact that your histologic grade is "well differentiated" is good news according to these number crunchers/soothsayers. But, really, if you were to widen the question to be: what is my prognosis? the answer may well be "it depends on whom you ask"? That is what happens with a disease with no man-made cure.