The relationship between histological grading of tumors and patient prognosis has long attracted the attention of oncologists. The degree of differentiation of breast cancer has a very close relationship with prognosis, but the various grading criteria vary considerably. Histological grading of breast cancer is mainly assessed from the following 3 aspects. Zhang Chenguang, Breast Surgery Department, Xinjiang Cancer Hospital
1. the degree of glandular duct formation, 2. the polymorphism of the nucleus, and 3. the nuclear division count. The following are different grading criteria: A. SBR grading criteria 1. Estimation of differentiation degree According to the ability to form glandular ducts or papillae: ① the whole tumor can be seen as 1 point. ② Not easily detectable is 3 points. 2. Polymorphism: ①Nuclear regularity, similar to mammary epithelium is 1 point. ②Nuclear apparent irregularity, with giant nuclei, malformed nuclei for 3 points. 3. Number of nuclear divisions (×400) ①1/10 HPF is 1 point. ②2/10HPF is 2 points. B. WHO grading criteria 1. glandular duct formation ①>75% for 1 point. ②2 points for 10%-75%. (3) <10% for 3 points. 2. nuclear pleomorphism ① small, regular, consistent morphology for 1 point. ②2 points for moderate variation in the shape and size of the nucleus. 3. the number of nuclear divisions (×400) ①0~5/10HPF is 1 point. ②6～10/10HPF is 2 points. C. Grading criteria for diagnosis and treatment of common malignant tumors in China 1. glandular duct formation 1 point for most obvious glandular ducts. ② Moderately differentiated glandular ducts is 2 points. 2. Irregularity of nucleus size, shape and chromatin 1 point for consistent nucleus size, shape and chromatin. 2 points for moderate irregularity of nucleus. ②Moderate irregularity of the nucleus is 2 points. 3. chromatin increase and nuclear division phase (×400) ①1/10HPF is 1 point. ②2～3/10HPF is 2 points. ③3 points for >3/10HPF. The scores determined by the three indicators of each criterion were summed, and 3-5 were classified as grade I (well differentiated), 6-7 as grade II (moderately differentiated), and 8-9 as grade III (poorly differentiated). Significance of histological grading of breast cancer The prognostic significance of histological grading of breast cancer has been recognized for a long time. We conducted a grading study on 476 breast cancer patients with more than 5 years of follow-up, and the results were that the 5-year survival rates of histological grading and survival of grade I, II and III were 82%, 63.4% and 49.5%, respectively, and the differences were significant (P<0.0l). Within the same clinical stage, the 5-year survival rate of patients decreased as the histological grade increased. Histologic grading was associated with DNA proliferation index and DNA ploidy, with a low proliferation index in well-differentiated breast cancers and conversely a high proliferation index in poorly differentiated ones. Using flow cytometry, it was confirmed that diploid breast cancers are often well differentiated, while heteroploid breast cancers are often poorly differentiated. Histologic grading and expression of growth factor receptors and oncogene products also correlate. Grade III breast cancers often have expression of epithelial growth factor receptors, suggesting poor prognosis, and expression of certain oncogene products, such as c-erbB2, suggesting poor patient prognosis, are often expressed in grade III breast cancers. Both histologic grading and histologic staging of breast cancer are pathologic factors affecting the prognosis of breast cancer, and of the two, histologic grading is more meaningful than staging in determining the prognosis of patients. In 1982, Ilaybiffle and Elston et al. considered that the three factors related to prognosis were (i) tumor size (pathological measurement), (ii) histological lymph node staging and (iii) histological grading, and derived the prognostic index in cox analysis The formula: prognostic index = 0.2 × tumor size + lymph node staging + histologic grading, patients with increased prognostic index have poor prognosis, and their arguments were confirmed by multiple case analyses later.