Alkushi et al developed a simple grading system for endometrial carcinoma that can separate tumors into low and high grade groups that correlate with patient outcome. It can be used on all endometrial carcinomas, regardless of the histologic type.
Parameters:
(1) growth pattern
(2) mitotic index (mitoses per 10 high powered microscopic fields, or HPF, using a 40x objective)
(3) nuclear atypia
Parameter
Finding
Points
growth pattern
not predominantly papillary or solid
0
predominantly papillary or solid
1
mitotic index
0 to 5 per HPF
0
>= 6 per 10 HPF
1
nuclear atypia
mild to moderate
0
severe
1
total score =
= SUM(points for the 3 parameters)
Interpretation:
• minimum total score: 0
• maximum total score: 3
Total Score
Grade
0 or 1
low grade
2 or 3
high grade
Performance:
• It was found to be an independent predictor of patient outcome after adjusting for FIGO stage, patient age and tumor cell type.
• The authors felt that the scheme was more reproducible than the FIGO grading scheme.
Limitations:
• As with any scheme using mitotic count, the index needs to be adapted to the different fields of view given by different microscope manufacturers.
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