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Topic: Bloom Richardson Score vs. Grade?

Forum: Surgery - Before, During, and After — Surgical options and helpful tips for recovery and side effects.

Posted on: Nov 30, 2012 04:59PM, edited Nov 30, 2012 05:05PM by shlee

shlee wrote:

Hi i am confused by the bloom richardson score vs the other grades given on my path report. I was told I have a grade 2 cancer by doctor. It seems pretty straight forward, but the bloom richardson score was never given as a number on my path report and I am getting a different number when i calculate it myself! I am getting grade one or a score of 5. I assume bloom richardson is used to determine grade. My question is, is bloom richardson score considered your grade or is histologic grade your grade? Much thanks!

Histologic Grade: II/III Score 2

Nuclear Grade: II/III Score 2

Mitotic Grade: I Score 1

Well to Moderately Differentiated

2+2+1=5 (Grade 1)

am i correct? Maybe my doctor read the report wrong?- he looked at very briefly and told me it is unimportant

Dx 9/2012, IDC, 1cm, Stage I, Grade 2, 0/3 nodes, ER+/PR+, HER2-
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Nov 30, 2012 05:22PM 1Athena1 wrote:

shlee - you are correct. And the Bloom-Richardson score is what your final "score" is. There are other forms of grading, but this is the one most commonly used in the US. The histologic grade is one of three factors used to calculate the Bloom Richardson score. The other two measure the rate of cell division and how normal or abnormal the cell nuclei are. I did not get the total score either and I don't know why that is; it may be because there are other indices used? That is my speculation.

Anyone diagnosed with cancer should learn to have a healthy disrespect for statistics. Statistics are maths. It's the science which still eludes us. Dx 3/2009, IDC, 3cm, Stage IIB, Grade 3, 3/8 nodes, mets, ER+/PR+, HER2-
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Nov 30, 2012 05:25PM SpecialK wrote:

This is a cut and paste explanation of histopathological grade.  It appears that if you are quoting from your report in your post that you have the nuclear and mitotic scores, but may be missing the cellular idfferentiation score, and may be including your overall score in the histological category, unless the differentiation score in under the histological heading.  If that is the case, it appears to be grade 1 based on the scores.  Sorry if this is just a restatement of your post, but it seems to be either missing info, or he read it wrong.
 
Histolopathologic Grade

This measure is often reported using some version of the Bloom Richardson or the Scarff-Bloom-Richardson scale. It is based on a combined score for nuclear grade, mitotic rate, and histologic grade or architectural differentiation. Each characteristic is given a score of 1 to 3, resulting in a total score ranging from 3 to 9.

  • Nuclear Grade
    Nuclear grade is assessed on a scale of 1-3. A grade I (low) indicates small nuclei with little variation in size and shape. A grade 3 (high) indicates larger nuclei with marked variation in size and shape. Grade 2 (intermediate) nuclei show features between 1 and 3. The higher the grade is, the more aggressive the tumor.
  • Mitotic Rate
    This rate indicates the number of malignant cells that are actively dividing. The mitotic rate is reported with numbers from 1 to 3. The higher the score the more aggressive the tumor cells.
  • Cellular Differentiation
    This measure is based on how close the specimen resembles normal breast tissue. This measure refers to tubular formation of the cells. A grade of 1 indicates a well-differentiated tissue with many tubules, grade 2 moderately differentiated, and grade 3 poorly differentiated tissue with few or no tubules.
BMX w/ TE 11/1/10, ALND 12/6/10. Twelve additional surgeries. TCHx6 2/17-6/2/11. Herceptin until 1/19/12. Femara 8/1/11, Arimidex 6/20/12, back to Femara 6/18/13-present. Dx 9/27/2010, IDC, Right, 2cm, Stage IIB, Grade 3, 2/14 nodes, ER+/PR+, HER2+ Dx 9/27/2010, DCIS, Stage 0, Grade 3
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Dec 6, 2012 08:40AM shlee wrote:

Hi ladies, thanks so much for your help. yea i guess i am just confused period. i also asked on the hopkins site and she said 2 but this just doesn't make sense and she didn't really explain why. and the doctor just looked very quickly so im not sure if the doctor really gave me correct grade. the doctor said it doesn't matter, but i would still like to know! 

This is exactly how my pathology report read:

Histologic grade:

II/III: moderate tubular formation (between 10% and 75% of tumor)

(score 2)

Nuclear grade:

II/III: moderate variation in size and shape

(score 2)

Mitotic Count:

<8 mitoses per 10 high power fields

(score 1)

I keep getting 5 and thats a grade 1 so im not sure why im being told grade 2

i realize its the highest of the grade 1 but it is still a grade 1! http://breastcancer.about.com/od/diagnosis/tp/tumor_grade.htm

ughhhh its so frustrating!

unless there are different ways of grading other than bloom richardson....

Dx 9/2012, IDC, 1cm, Stage I, Grade 2, 0/3 nodes, ER+/PR+, HER2-
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Dec 6, 2012 09:10AM SpecialK wrote:

Sometimes the Nottingham score is used - here is a link that explains it (kind of), but it should say on the path report what system was used.

http://www.oncolink.org/experts/article.cfm?id=2221 

BMX w/ TE 11/1/10, ALND 12/6/10. Twelve additional surgeries. TCHx6 2/17-6/2/11. Herceptin until 1/19/12. Femara 8/1/11, Arimidex 6/20/12, back to Femara 6/18/13-present. Dx 9/27/2010, IDC, Right, 2cm, Stage IIB, Grade 3, 2/14 nodes, ER+/PR+, HER2+ Dx 9/27/2010, DCIS, Stage 0, Grade 3
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Feb 20, 2013 08:14AM knits wrote:

This might be a little late. But they have 2 options, give you a total score which would be 5, or the grade it falls into. For grade 1=would be score 1-5