Lax et al developed a binary grading system based on histologic appearance of endometrioid adenocarcinoma of the endometrium. This was felt to be simpler and more reproducible than previous histologic grading schemes. The authors are from the Johns Hopkins University, University of Maryland and University of Graz (Austria).
Histologic parameters:
(1) histologic extent of solid growth: no distinction is made between squamous and nonsquamous appearance
(2) pattern of invasive growth:
(a) Diffuse infiltration shows irregularly distributed glands, masses, cords or nests of tumor cells infiltrating the myometrium haphazardly.
(b) Expansive growth shows lobulated tumor with pushing borders.
(3) tumor cell necrosis: Areas of necrotic tumor immediately adjacent to viable tumor. This does NOT apply to single cell necrosis OR necrotic debris within masses of squamous epithelium.
In situ tumors are only evaluated for growth pattern and tumor cell necrosis.
|
Parameter |
Finding |
Points |
|
solid growth pattern |
<= 50% |
0 |
|
|
> 50% |
1 |
|
invasive growth pattern |
in situ |
0 |
|
|
expansive, "pushing" |
0 |
|
|
diffusely infiltrative |
1 |
|
tumor cell necrosis |
absent |
0 |
|
|
present |
1 |
binary architecture score =
= SUM(points for the 3 histologic parameters)
Interpretation:
• minimum score: 0
• maximum score: 3
|
Score |
Tumor Grade |
|
0 or 1 |
low grade |
|
2 or 3 |
high grade |
|
Tumor Grade |
Tumor Stage |
5 Year Survival Rate |
|
low grade |
IA or IB |
100% |
|
|
IC |
74% |
|
|
II to IV |
76% |
|
high grade |
IA |
100% |
|
|
IB |
67% |
|
|
IC |
76% |
|
|
II to IV |
26% |
from Summary page 1201, Figure 2 page 1204, and Table 4 page 1205
Differences in prognosis between low and high grade tumors seen with:
(1) Stage IB (100% vs 67%)
(2) Stage II to IV (76% vs 26%)
Performance:
• Interobserver agreement showed a kappa coefficient of 0.65.
• Intraobserver agreement showed a kappa coefficient of 0.79.
• Both measures were found better than use of the FIGO or nuclear grading techniques.
Specialty: Hematology Oncology, Surgery, general, Obstetrics & Gynecology
ICD-10: ,
