What is the Nottingham combined histologic grade (modified Scarff-Bloom-Richardson grade) system for breast tumors?

Updated: Mar 20, 2019
  • Author: Oudai Hassan, MD; Chief Editor: Chandandeep Nagi, MD  more...
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Answer

Answer

Histologic grade reflects how far the tumor architecture and cytology deviate from normal, and how rapidly the tumor proliferates. The College of American Pathologists (CAP) recommends the use of the Nottingham combined histologic grade, also called the modified Scarff-Bloom-Richardson grading system (see Table 2). [5]

Table 2. The Nottingham Combined Histologic Grade (Modified Scarff-Bloom-Richardson Grade) (Open Table in a new window)

Feature

 

Score

Tubule formation

>75%

1

10-75%

2

< 10%

3

Nuclear pleomorphism

Small, regular uniform cells

1

Moderate increase in size and shape

2

Marked variation

3

Mitotic counts per 10 high-power field (HPF) (field diameter, 0.52 mm)

0-7

1

8-15

2

≥16

3

Scoring

3-5 points

Well differentiated

Grade 1

6-7 points

Moderately differentiated

Grade 2

8-9 points

Poorly differentiated

Grade 3


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