Grade 1 or Grade 2? Nottingham Score of 4.

Stacey - it's more important to determine if you are ER or PR +/- and HER2 +/- in order for the docs to recommend what treatment. And maybe to get genetic testing based on those answers. Grade can change and may be different after surgery anyway.

Anne, yes, from my understanding, a '4' Nottingham score should be grade 1.

When I first read your post, I was wondering if you might have one element of the grade that straddles two scores - in the detail of my pathology report, my nuclear grade was noted as being a '1' in one area of my pathology and '1-2' in another area, so it was counted as '2' in my Nottingham grade, which bumped up my grade from a 1 to a 2. But that wouldn't make sense for you since Nottingham scores of 3, 4 or 5 are all counted as being grade 1.

Grade actually can impact the Stage, based on the new pathological prognostic staging criteria included as part of the AJCC Breast Cancer Staging update in 2018. In your case, with such a small tumor and being ER+/PR+, you would be Stage IA whether your tumor is grade 1, grade 2 or grade 3, but if your tumor was either PR- or larger, a grade increase could increase the Stage.

yes, that happened to me. My biopsy was listed as grade 2. When my slides were transferred, new place listed as grade 1. I was the only one who caught the difference. When my doc looked into it, the biopsy place only went by the nuclear grade ( I think that’s what it was, it’s kinda fuzzy now) and not the whole score. You’d think everyone would use the same system, turns out they don’t! I don’t remember what my exact breakdown was for my score, but it was a 5.

I had a mistake on my pathology report that listed me a pt1a, when in actuality it was pt1c. I brought it to the attention of the head of BC Surgery and he was going to tell the powers that be about it. Apparently pathology mistakes are not that uncommon.