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THE MSBR
BREAST CANCER GRADING SYSTEM
Introductory
concepts
Same
as for Elston
system.
preparing a sample for grading
Same as for Elston system.
here are the grading
parameters:
The "mSBR grade" (modified Scarf-Bloom-Richardson)
is arrived at (by pathologists) by evaluating the cancer for the following two parameters in
order to "sum" or add-up the designated points in order to produce an Arabic numerical sum
score. Score ranges equate to Roman-numeral grades, there being four grades. MSBR stands for
"modified Scarff-Bloom-Richardson method".
- TUBULES: (a pattern or architectural parameter assessing cellular
organization...the tumor's ability to maintain some semblance of normal order...how bad
the tissue
organization looks)......not a
factor in this system
- NUCLEAR [size/shape] VARIATION: (a cytological/cellular
parameter...how bad the cells look [B-R grade here])
1 point, if only mild nuclear enlargement, no/mild darkening of
chromatin [nuclear DNA/chromosomes], no/mild variation of nuclear shapes and sizes.
2 points, if moderate such
changes.
3 points, if nuclei quite
large, or bizarre, or have prominent nucleoli, and are quite dark
[hyperchromatic]
- MITOTIC ACTIVITY:
(a growth-rate parameter which is determined in the tumor area showing the fastest growth
rate, usually the tumor periphery, counting the number of mitotic figures in ten
high-power microscopic fields [hpf]...400x [40x objective and 10x ocular])
1 point, 0-1 mitotic figures per 40x high-power field.
2 points, 2 " " " " "
3 points, 3 or more " " " "
now the assignment of
grade
Now, having assigned the points for the two parameters, one simply adds them up
and compares to the following list. For example: a tumor has moderate nuclear abnormalities (2
points), and 2 mitotic figures per hpf (2 points)...a total of 2 pt. plus 2 pt. equals a total 4
points. This assigning of numerical values adds a sort of discipline to the pathologist's
estimations.
- 2 total
points is defined as mSBR Group I
- 3 total points is defined as
mSBR Group 2
- 4 total points is defined as
mSBR Group 3
- 5 total points is defined as
mSBR Group 4
- 6 total points is defined as
mSBR Group 5
Dr. Le Doussal, champion of this system, found
that Groups 1-3 accounted for 33% of the total cases and had a distinctly lower risk for
developing metastasis than even Groups 3 & 4. That is, patients with well differentiated
tumors and low mitotic counts have an excellent prognosis.
commentary
qualification
Same as
for Elston
system.
Some Official
References
- Le Doussal V., et.
al., Prognostic Value of Histological Grade Nuclear Components...
Cancer [a journal] 64:1914-1921, 1989.
- Joensuu H, et. al.,
Late Mortality from..., Cancer [a journal].
85:2183-2189,1999.
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(posted 3 December 2000)
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