Grade Pathological

This input is used for staging


**Note 1:** Pathological grade must not be blank. **Note 2:** Assign the highest grade from the primary tumor. If the clinical grade is the highest grade identified, use the grade that was identified during the clinical time frame for both the clinical grade and the pathological grade. (This follows the AJCC rule that pathological time frame includes all of the clinical time frame information plus information from the resected specimen.) * If a resection is done of a primary tumor and there is no grade documented from the surgical resection, use the grade from the clinical workup * If a resection is done of a primary tumor and there is no residual cancer, use the grade from the clinical workup **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 * No resection of the primary site * Neo-adjuvant therapy is followed by a resection (see post therapy grade) * Clinical case only (see clinical grade) * There is only one grade available and it cannot be determined if it is clinical, pathological, or after neo-adjuvant therapy * 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 #3844


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