Original and Modified Joshi Histologic Grading Criteria for Neuroblastomas

Description

Joshi et al proposed histologic grading criteria for neuroblastomas in 1992 using mitotic rate and calcification status. This was modified in 1996 with the mitotic karyorrhexis index used in place of the mitotic index. This correlates with the Shimada classification but is easier to apply, since the degree of differentiation does not need to be determined.

Original (1992)

Histologic Features	Grade
mitotic rate low (<= 10/10 HPF), AND calcification present	I
mitotic rate low (<= 10/10 HPF), OR calcification present	II
mitotic rate high (> 10/10 HPF), AND calcification absent	III

Counting mitoses (Joshi, 1992, page 2200):

(1) count in most mitotically active area at x400 magnification

(2) 10 high powered fields counted on each of 4 sections from the tumor, with the maximum count used for grading

(3) features of mitosis (vs karyorrhexis): absent nuclear membrane, presence of hairy or spiky projections, and basophilic or clear cytoplasm

(4) doubtful structures are not counted

Modified (1996)

Histologic Features	Grade
mitotic karyorrhexis index low (<= 4%), AND calcification present	I
mitotic karyorrhexis index low (<= 4%), OR calcification present	II
mitotic karyorrhexis index NOT low (> 4%) AND calcification absent	III

where:

• mitotic karyorrhexis index (MKI) = number of cells showing mitotic activity or nuclear karyorrhexis in 5,000 cells (200 cells = 4%)

Features of karyorrhectic cells (Joshi, 1992, pages 2200-2201)

(1) condensed punctate or lobular nuclear material

(2) eosinophilic dense cytoplasmic staining

The MKI can be estimated (Joshi, 1996, page 1584-1585, Table III) by scanning an area for its cell density and counting the number of cells showing mitoses or karyorrhexis (MKC = mitotic or karyorrhectic cells)

Cell Density	Tumor Cells per HPF	Low MKI if number MKC	High MKI if number MKC
sparse	100	<= 4	> 4
sparse	200	<= 8	> 8
sparse to moderate	300	<= 12	> 12
moderate	400	<= 16	> 16
moderate	500	<= 20	> 20
moderate to dense	600	<= 24	> 24
dense	700	<= 28	> 28
dense	800	<= 32	> 32
dense	900	<= 36	> 36

Prognostic Groups

Grade	Age of Patient	Prognosis
I	any age	low risk (good)
II	<= 1 year of age	low risk (good)
II	> 1 year of age	high risk (poor)
III	any age	high risk (poor)

Note: In the abstract to Joshi 1996, it refers to grade II as low risk if < 1 year and high risk if >= 1 year. However, Tables 2 and 6 use <= 1year and > 1 year.

5 year survival in 1996:

• low risk group: 93%

• high risk group: about 48%

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Original and Modified Joshi Histologic Grading Criteria for Neuroblastomas

Description

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