more tubules = chemo benefit

From the article, it says that forming tubules raises risk:

"Pathologists currently use three features to grade tumors: mitoses, distinct forms of cell nuclei, called nuclear pleomorphism, and tubules. More of each increases the risk the cancer is aggressive and requires chemotherapy."

But I thought that lobular cancer doesn't form tubules and in the grading system, ILC typically gets a 3 out of 1-3 for this feature in the grading scheme. Doesn't this imply that forming lots of tubules would result in a lower score on this feature. it seems to contradict....??

Actually, the Nottingham score assigns a score of 1 to 3 for each of three factors--tubule formation, cell differentiation and mitotic rate. The higher the score given a factor, the higher the likelihood of it being aggressive. Tubule formation is an inverse correlation--the more tubules, the lower the score. So a tumor with a high number of tubules scores a 1, while one with few tubules gets a 3 for that factor. My tumor got a 2 for moderate differentiation, a 3 for few tubules, and a 1 for low mitotic rate. Add them up and get a Nottingham Score of 6--which corresponds to Grade 2. My OncotypeDX score would likely have been lower had my tumor formed more tubules.

Yeah, I looked at the study, and it indicated tubule count was of normal tubules, so more was a positive indicator. ChiSandy and Kathy are right, a score of 1 is for more than 75% tubules ( 2 is for 10-75%, and 3 is for <10%). The study found the lower tubule score (1) (which means higher number of tubules) correlated with low Oncotype dx score and the high tubule score (3) (meaning fewer tubules), correlated with the high Oncotype dx score. They didn't look at intermediate scores, which are probably a lot trickier.

The study itself was more about the computerization of the pathology done counting tubules. I really didn't see anything about it being a cheap replacement for Oncotype dx. That would be a stretch since they didn't even deal with intermediate cases. And there was nothing saying the more tubules, the more the patient will benefit from chemotherapy. I think the Science Daily writer really got it wrong.

You're right Kayb, just being able to identify low-risk patients without gene arrays will reduce cost and over-treatment, so this should be a big boon in countries with small health care budgets. (Narrowing the intermediate pool can come later)