Grade Post Therapy

Notes

**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

NAACCR Item

NAACCR #3845

Metadata

SSDI
Code Description
1 G1: Low combined histologic grade (favorable), SBR score of 3–5 points
2 G2: Intermediate combined histologic grade (moderately favorable); SBR score of 6–7 points
3 G3: High combined histologic grade (unfavorable); SBR score of 8–9 points
L Nuclear Grade I (Low) (in situ only)
M Nuclear Grade II (interMediate) (in situ only)
H Nuclear Grade III (High) (in situ only)
A Well differentiated
B Moderately differentiated
C Poorly differentiated
D Undifferentiated, anaplastic
9 Grade cannot be assessed (GX); Unknown
<BLANK> See Note 1