Grade Clinical

This input is used for staging


**Note 1:** Grade Clinical must not be blank. **Note 2:** Assign the highest grade from the primary tumor assessed during the clinical time frame. **Note 3:** If there are multiple tumors with different grades abstracted as one primary, code the highest grade. **Note 4:** 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 5:** 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 6:** 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 7:** Grade from nodal tissue may be used **ONLY** when there was **never** any evidence of primary tumor (T0). Grade would be coded using G1, G2, or G3, even if the grading is not strictly Nottingham, which is difficult to perform in nodal tissue. Some of the terminology may include differentiation terms without some of the morphologic features used in Nottingham (e.g., well differentiated (G1), moderately differentiated (G2), or poorly/undifferentiated (G3)). * *Example:* No breast tumor identified, but 2/3 axillary nodes were positive. Determined to be regional node metastasis from breast primary. Nodes were described as poorly differentiated with a high mitotic rate - Code G3 based on the poorly differentiated (which is a high grade) although the terminology used is for nuclear grading **Note 8:** Code 9 (unknown) 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 9:** If there is only one grade available and it cannot be determined if it is clinical or pathological, assume it is a Grade Clinical and code appropriately per Grade Clinical categories for that site, and then code unknown (9) for Grade Pathological, and blank for Grade Post Therapy Clin (yc) and Grade Post Therapy Path (yp). **Note 10:** 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 Stated as Nottingham/Scarff Bloom-Richardson Grade 1
2 G2: Intermediate combined histologic grade (moderately favorable); SBR score of 6-7 points Stated as Nottingham/Scarff Bloom-Richardson Grade 2
3 G3: High combined histologic grade (unfavorable); SBR score of 8-9 points Stated as Nottingham/Scarff Bloom-Richardson Grade 3
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