Brandwein et al developed a histologic score for mucoepidermoid carcinoma of salivary glands based on the AFIP score of Goode et al. The authors are from multiple institutions including Mount Sinai School of Medicine, Memorial Sloan Kettering Cancer Center, and the University of Virginia.
|
Histologic Grade |
Features |
|
I |
prominent goblet cell component; intermediate cells may be prominent; circumscribed growth pattern; lack of aggressive invasion pattern and grade III defining features |
|
II |
intermediate cells predominate over mucinous cells; squamous cells may be seen; mostly solid tumor; shows an aggressive invasion pattern |
|
III |
squamous cells predominate; intermediate and mucinous cells also present; mostly solid; defining features include necrosis, perineural spread, vascular invasion, bony invasion, mitotic activity and anaplasia |
Parameters from the AFIP score:
(1) intracystic component
(2) nuclear atypia
(3) mitotic activity
(4) perineural spread
(5) necrosis
Additional criteria:
(6) tumor growth pattern
(7) lymphatic and/or vascular invasion
(8) bony invasion
|
Parameter |
Finding |
Points |
|
intracystic component |
< 25% |
2 |
|
|
>= 25% |
0 |
|
nuclear atypia |
pronounced (anaplasia) |
2 |
|
|
not pronounced |
0 |
|
mitotic activity |
> 4 mitoses in 10 high power fields (HPF) |
3 |
|
|
<= 4 mitoses in 10 HPF |
0 |
|
perineural spread |
present |
3 |
|
|
absent |
0 |
|
necrosis |
present |
3 |
|
|
absent |
0 |
|
tumor growth pattern |
invasion in small nests or individual cells |
2 |
|
|
cohesive islands |
0 |
|
lymphatic and/or vascular invasion |
present |
3 |
|
|
absent |
0 |
|
bony invasion |
present |
3 |
|
|
absent |
0 |
where:
• A high power field uses a 40x objective lens.
histologic score =
= SUM(points for all 8 parameters)
Interpretation:
• minimum score: 0
• maximum score: 21
• A high score correlates with poor differentiation of the tumor.
|
Score |
Grade |
|
0 or 1 |
Grade I |
|
2 or 3 |
Grade II |
|
>= 4 |
Grade III |
Performance:
• The disease free interval was affected by tumor grade, stage and negative margin status.
• The system is reproducible without the tendency to downgrade the carcinoma seen with the original AFIP criteria.
Specialty: Hematology Oncology, Surgery, general, Otolaryngology
