Grade Clinical

This input is used for staging


**Note 1:** Clinical grade must not be blank. **Note 2:** Assign the highest grade from the primary tumor assessed during the clinical time frame. **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 * Grade from primary site is not documented * Clinical workup is not done (for example, cancer is an incidental finding during surgery for another condition) * Grade checked "not applicable" on CAP Protocol (if available) and no other grade information is available **Note 7:** If there is only one grade available and it cannot be determined if it is clinical or pathological, assume it is a clinical grade and code appropriately per clinical grade categories for that site, and then code unknown (9) for pathological grade, and blank for post therapy grade. **Note 8:** 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 #3843


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