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 |
Pleomorphic Nuclear Atypia |
Necrosis |
Grade |
(-) |
(-) |
1 (low) |
+ (++) |
(-) |
2 (moderate) |
(-) |
+ (++) |
2 |
+ |
+ |
2 |
+++ |
+++ |
3 (high) |
+++ |
(-) |
3 |
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.
Specialty: Hematology Oncology, Surgery, general, Obstetrics & Gynecology
ICD-10: ,