Help! My mom's pathology Report lists different grades

The SBR score correctly sums to 8, with Nuclear Grade in at 3.

Grade is noted to be "Grade 3 (scores of 8 or 9)". This is consistent with the SBR score.

The problem is that the factors under "Grade" add to 7 rather than 8. The reason is the different score for Nuclear Pleomorphism, listed as being a 2 versus Nuclear Grade at a 3. Since the total score of 8 correlates across both pages, it seems that the typo, if there is one, is with Nuclear Pleomorphism, which should be a 3, in which case the three "Grade" factors would correctly sum to the total of 8, and the Nuclear score would become consistent across both pages. Changing that one number from a 2 to a 3 makes everything else consistent and add correctly. The other way around, if you were to assume Nuclear Pleomorphism to be "2", it would mean that 3 other numbers would now become inconsistent or add incorrectly (SBR total, Nuclear Grade and Grade total).

One thing that might have caused this inconsistency is that the nuclear grade could be different in different parts of the tumor. My nuclear grade was noted on my pathology report as being "1 - 2" but for the Nottingham grade scoring (similar to SBR), it was counted as a 2. This bumped my total grade up from a 1 to a 2, which is mildly annoying but in the end makes no difference.

And that's what's key, which is that it really doesn't matter because it won't change a thing about the treatment plan. You have to keep in mind that these assessments are made by pathologists looking at cells under a microscope. There is a level of subjectivity and it's not uncommon for there to be small differences from one pathologist to another. What one pathologist assessed to be a 2 on nuclear grade could be seen to be a 3 by another pathologist. That too could be why the report has this small inconsistency.

In the end however, both total grade scores are the same (8) so I think you can confidently assume that to be correct.

I understand that grade 3 is more aggressive. However depending on the make up of the three components, it might be just a little bit more aggressive than a grade 2, or it might be much more aggressive than a grade 2. A 6-point grade 2 would be considerably less aggressive than a 9-point grade 3 but the difference between a 7-point grade 2 and an 8-point grade 3 would be much less significant. A good MO will look at the components of the score as well as the total score, and not just whether it's recorded as grade 2 or grade 3.

That said, your mother is 80; in her case, the difference between grade 2 and grade 3, all other things being equal, will not change her treatment plan.

I stand by my first response. Either the Pathologist made 1 mistake (the Nuclear Grade was mistated as 2 rather than 3) or the Pathologist made 3 mistakes (he incorrectly added the 3 components on the first page, and then input in the wrong Nuclear Pleomorphism score on the second page and incorrectly carried over the wrong sum total on the second page).

Wow.

I wasn't being defensive; I was saying that the revision in the information you've provided doesn't change what I said in my first response. I spent a long time trying to write a clear, logical and explanatory answer when I first responded. You thanked me for my "detailed reply". I didn't think it was necessary for me to rewrite all that detail when I was saying that my original answer and explanation still stands, even with your revised information.

I appreciate that you are looking for the most optimistic interpretation, but do you think it is more likely that the Pathologist made 3 errors in the report, or 1 error? Look at that question in the context of my first reply. I am not being unsympathetic or insensitive; I am trying to help you determine what happened with the report and what you should assume the grade most likely is.

I wish the best to your mother.

The report was written by the pathologist so the logical person to address regarding the discrepancy, would be the pathologist. The BS will not address what may be a discrepancy in the report because it is not their place to question the contents of the report, only to discuss what was reported. Same goes for the oncologist. So be tactful in your approach about your concerns with the difference in numbers. I hope you get the clarification you so need.

I will second AliceBastable's suggestion about trying to lower your Mother's stress level.

hi. I have found so many inaccuracies and mistakes in my moms reports. It sure is frustrating because indeed it is your moms life and I completely understand wanting to clear up before meeting with the MO. In one instance, my moms breast MRI stated benign Foci in the left when she just had a biopsy of IDC in the left breast and it first showed as a spiculated density on her first MRI. I called the the nurse told me that it must have shrunk with Letrizole. I responded that it was there a week ago on ultrasound so ummmmm, no. In any case the surgeon spoke with the radiologist who had an addendum with the finding. There have been many other errors such as calling the IDC a tubular carcinoma because it had tubular features and on and on. I, like you, do not want to diminish her faith in her treatment and team so most of the time I only tell her when it is cleared up. Of course her MO and surgeon do not seem to care at all about her IDC and focus only on her extensive ILC. I read each and every report and I have never seen this in my patients records. I am a NP and am very familiar but have not encountered these types of issues until now. I am glad that you are pursuing thi

I’ve learned that grade can be subjective to the pathologist. My grade was 2 but my oncotype was extremely low even though my ki-67 was high. Three different doctors told me that the oncotypedx trumps grade. Also many docs don’t put much faith in the ki-67 score nowadays. I hope your mom has a low score. I would imagine at her age chemo might not be recommended and she’ll be prescribed an aromatase inhibitor. They are very powerful and should kick this stuff to the curb.

My pathology report incorrectly reported the tumor as pt1a, when in actuality it was pt1c. I brought that up to the head of breast surgery and he said he’d mention it to whoever tracks that. Unfortunately errors are very common. We all have to be our own best advocates.