Grading Ductal Carcinoma in Situ Using the AFIP System of Tavassoli et al

Tavassoli et al developed a grading system for ductal carcinoma in situ of the breast at the Armed Forces Institute of Pathology (AFIP).

Parameters used for grading

(1) pleomorphic nuclear atypia

(2) necrosis

Necrosis and/or Apoptosis	Necrosis
absent, OR 1-4 nuclear fragments	(-)
>= 5 nuclear fragments	+ (++)
lumen distended by abundant nuclear debris	+++

Pleomorphic Nuclear Atypia	(-)	+ (++)	+++
chromatin	diffuse	diffuse	vesicular or clumped
nuclear membrane	smooth	occasional shallow indentations	frequent, multiple indentations
nuclear shape	round, oval or spindle	round, oval with occasional clefts	multiple clefts, popcorn
nuclear size variation	minimal if any	rare cells, over 2-fold	3-fold or more not uncommon
nucleoli	absent (present if apocrine change)	absent or present, often few and small	often present, often multiple and large

In addition to the grade of the tumor, the cell type should be specified if the cell type is uncommon, such as apocrine, signet ring, or clear cell.

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