surgical pathology report

Hi geocachelinda,

The information you have posted here about the Nottingham grade is telling you more about what the tumor cells looked like under the microscope.  The pathologist uses criteria to grade the cells to establish for the doctor how likely the cells are to have spread beyond the breast and how fast the cells are growing.  They look at the cells in terms of how much they are shaped like normal cells (tubule formation) and give it a score of 1, 2, or 3.  Lobular breast cancer never looks like normal cells so it always gets a 3 in this category.  This means that it is kind of meaningless for lobular cancer grading.  Another category is how much the nucleii of the cells look like normal breast cells.  1 means the nucleii are small and uniform and most like normal breast cells, 2 means some of the nucleii may be larger or look moderately different.  3 means most of the nucleii are large and varied in shape.  There is a continuum of "nuclear pleomorphism" and pathologists try to figure out where your cells are on the continuum to give you a score.  Yours is 2, kind of in the middle.  The mitotic grade refers to how fast the cells seem to be dividing.  1 refers to few mitosis (dividing cells) so it's slow growing.  Again there is a continuum of growth rate and the pathologist decides, based on how many divisions he sees in the field he is examining under the microscope, how fast the tumor was growing at the time it was sampled or removed.  Your score of 2 for mitotic grade puts you again in the middle.  So with all this information added up you get a grade of 7/9 which is considered an intermediate grade, or grade 2, score.  This score was sometimes referred to as the SBR (Scarff-Bloom-Richardson system) used in the US.  It was modified later by Elston-Ellis to make pathologists more consistent. Then it was called the Nottingham Grading System, used in Europe previously and also in the US now.

There is a totally different thing, called the NPI (Nottingham Prognostic Index) in Europe, which uses your tumor size, number of nodes, and grade to get a prognostic grade.  That's not what they're talking about here.  That's more like what we call staging here in the US. 

I hope this isn't too much information.  It just would have helped me to have all these terms explained so I would understand what I was reading when I read articles and could talk about things with my oncologist.