Grade Post Therapy
**Note 1:** Leave post-therapy grade blank when
* No neoadjuvant therapy
* Clinical or pathological case only
* There is only one grade available and it cannot be determined if it is clinical, pathological or post-therapy
**Note 2:** Assign the highest grade from the resected primary tumor assessed after the completion of neoadjuvant therapy.
**Note 3:** Priority order for codes
* Invasive cancers: codes 1-3 take priority over A-D.
* In situ cancers: codes L, M, H take priority over A-D
**Note 4:** Scarff-Bloom-Richardson (SBR) score is used for grade. SBR is also referred to as: Bloom-Richardson, Nottingham, Nottingham modification of Bloom-Richardson score, Nottingham modification, Nottingham-Tenovus grade, or Nottingham score.
**Note 5:** All invasive breast carcinomas should be assigned a histologic grade. The Nottingham combined histologic grade (Nottingham modification of the SBR grading system) is recommended. The grade for a tumor is determined by assessing morphologic features (tubule formation, nuclear pleomorphism, and mitotic count), assigning a value from 1 (favorable) to 3 (unfavorable) for each feature, and totaling the scores for all three categories. A combined score of 3–5 points is designated as grade 1; a combined score of 6–7 points is grade 2; a combined score of 8–9 points is grade 3.
* Do not calculate the score unless all three components are available
**Note 6:** Code 9 when
* Surgical resection is done after neoadjuvant therapy and grade from the primary site is not documented
* Grade checked “not applicable” on CAP Protocol (if available) and no other grade information is available
**Note 7:** If you are assigning an AJCC 8th edition stage group
* Grade is required to assign stage group
* Codes A-D are treated as an unknown grade when assigning AJCC stage group
* An unknown grade may result in an unknown stage group