Hasebe et al developed a new classification system for women with infiltrating ductal carcinoma of the breast. It is based on three histologic findings - nuclear atypia, fibrotic focus, and extramammary fat invasion. The authors are from the National Cancer Center Research Institute and Hospital East in Chiba, Japan.
Parameters:
(1) nuclear atypia
(2) fibrotic focus (area of sclerosis)
(3) extramammary fat invasion (This refers to the fat surrounding breast ducts, lobules and stroma.)
Parameter |
Finding |
Points |
nuclear atypia |
mild (Grade I) or moderate (Grade II) |
0 |
|
marked (Grade III) |
1 |
fibrotic focus |
absent |
0 |
|
present |
1 |
extramammary fat invasion |
none or <= 2 mm |
0 |
|
> 2 mm |
1 |
where:
• The depth of fat invasion is the distance between the edge of the "mammary tissue" and the furthest edge of advancing tumor. The points chosen for the "mammary tissue" margin could vary between observers.
NNF score =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 0
• maximum score: 3
• The higher the NNF score, the greater the chance for recurrence, the shorter the disease free survival and the worse the survival.
NNF Score |
5 Year Disease Free Survival |
5 Year Survival Rate |
0 or 1 |
83% |
97% |
2 |
60% |
79% |
3 |
31% |
64% |
from Figure 6, page 1365, with 5 years = 1825 days
Other high risk factors associated with tumor recurrence:
(1) tumor size > 20 mm
(2) > 3 lymph nodes with metastases
(3) presence of skin invasion
Specialty: Hematology Oncology, Surgery, general, Obstetrics & Gynecology
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