Background
Methods
Cases in the study
Participating pathologists
Classification systems assessed
Holland | |||
---|---|---|---|
High grade | Intermediate grade | Low grade | |
Nuclei | Pleomorphic nuclei, anisonucleosis, irregular location, usually but not always large | Slight pleomorphism, nuclei showing some variation in size, outline and spacing | Monomorphic nuclei of uniform size, regular outline and spacing, usually small |
Chromatin | Vesicular | Fine to coarse | Uniform, fine |
Nucleoli | 1 or more | Infrequent | No nucleoli |
Mitoses | Often present | Occasionally present | Rare |
Van Nuys
| |||
High grade
|
Intermediate grade
|
Low grade
| |
Nuclei diameter | >2 RBC | 1.5–2 RBC | 1–1.5 RBC |
Chromatin | Vesicular | Fine to coarse | Uniform, fine |
Nucleoli | 1 or more | Infrequent | No nucleoli |
Comedo-necrosis | Present or absent | Present | Absent |
Black Modified Nuclear Grade
| |||
High grade
|
Intermediate grade
|
Low grade
| |
Nuclei | Pleomorphic nuclei, anisonucleosis, irregular location, usually but not always large | Slight pleomorphism, nuclei showing some variation in size, outline and spacing | Monomorphic nuclei of uniform size, regular outline and spacing, usually small |
Nuclei diameter | Up to 3 times the diameter of normal nuclei | Up to 2 times the diameter of normal nuclei | Same as normal nuclei |
Chromatin | Vesicular | Fine to coarse | Uniform, fine |
Nucleoli | 1 or more | Infrequent | No nucleoli |
Mitoses | Often present | Occasionally present | Rare |
Web-based model
Holland | Van Nuys | Modified black nuclear grade system |
---|---|---|
G1 if final score <6
|
G1 if final score <50
|
G1 if final score <6
|
(1) monomorphic nuclei of uniform size, regular outline and spacing | (10) Nuclei 1.5 -2 RBC diameter or nuclear size in relation to normal duct: 2 fold variation in nuclear diameter | (1) monomorphic nuclei of uniform size, regular outline and spacing |
or | ||
(1) uniform, fine chromatin | (1) Nuclei 1-1.5 RBC diameter or nuclear size in relation to normal duct: similar, minimal enlargement | (1) Nuclei 1-1.5 RBC diameter or nuclear size in relation to normal duct: similar, minimal enlargement |
(1) no nucleoli | (10) fine to coarse chromatin | (1) uniform, fine chromatin |
or | ||
(1) no mitoses | (1) uniform, fine chromatin | (1) no nucleoli |
(1) all the cells have a well-defined apex and show polarization | (2) nucleoli insignificant | (1) no mitoses |
or | ||
(1) no nucleoli | ||
(10) any confluent necrosis | ||
or | ||
(1) no necrosis | ||
G2 if final score >5 and <90
|
G2 if final score >1000 and <1030
|
G2 if final score >5 and <90 or >13 and <16 if no mitoses
|
(10) nuclei showing some variation in nuclear size, outline and spacing | (10) Nuclei 1.5 -2 RBC diameter or nuclear size in relation to normal duct: 2 fold variation in nuclear diameter | (10) nuclei showing some variation in nuclear size, outline and spacing |
or | or | or |
(1) monomorphic nuclei of uniform size, regular outline and spacing | (1) Nuclei 1-1.5 RBC diameter or nuclear size in relation to normal duct: similar, minimal enlargement | (1) monomorphic nuclei of uniform size, regular outline and spacing |
(10) fine to coarse chromatin | (10) fine to coarse chromatin | (10) nuclei 1.5 -2 RBC diameter or nuclear size in relation to normal duct: 2 fold variation in nuclear diameter |
or | or | or |
(1) uniform, fine chromatin | (1) uniform, fine chromatin | (1) nuclei 1-1.5 RBC diameter or nuclear size in relation to normal duct: similar, minimal enlargement |
(2) nucleoli insignificant) | (2) nucleoli insignificant | (10) fine to coarse chromatin |
or | or | or |
(1) no nucleoli | (1) no nucleoli | (1) uniform, fine chromatin |
(10) mitoses present | (1000) proeminent central necrosis - comedonecrosis | (2) nucleoli insignificant |
or | or | |
(1) absent | (1) no nucleoli | |
(10) polarization present but not pronouced | (1) no mitoses | |
or | ||
(1) all the cells have a well-defined apex and show polarization | ||
G3 if final score >95
|
G3 if final score >100 and <320 or >1100
|
G3 if final score >95 or >13 and <16 if mitoses are present
|
(100) pleomorphic nuclei, anisonucleosis, usually but not always large | (100) nuclei >2 RBC diameter or nuclear size in relation to normal duc: 3 fold variation in nuclear diameter | (100) pleomorphic nuclei, anisonucleosis, usually but not always large |
or | or | or |
(10) nuclei showing some variation in nuclear size, outline and spacing | (10) nuclei 1.5 -2 RBC diameter or nuclear size in relation to normal duct: 2 fold variation in nuclear diameter | (10) nuclei showing some variation in nuclear size, outline and spacing |
or | or | or |
(1) monomorphic nuclei of uniform size, regular outline and spacing | (1) nuclei 1-1.5 RBC diameter or nuclear size in relation to normal duct: similar, minimal enlargement | (1) monomorphic nuclei of uniform size, regular outline and spacing |
(100) coarse, clumped chromatin | (100) coarse, clumped chromatin | (100) nuclei >2 RBC diameter or nuclear size in relation to normal duc: 3 fold variation in nuclear diameter |
or | or | or |
(10) fine to coarse chromatin | (10) fine to coarse chromatin | (10) nuclei 1.5 -2 RBC diameter or nuclear size in relation to normal duct: 2 fold variation in nuclear diameter |
or | or | or |
(1) uniform, fine chromatin | (1) uniform, fine chromatin | (1) nuclei 1-1.5 RBC diameter or nuclear size in relation to normal duct: similar, minimal enlargement |
(10) evident nucleoli | (10) evident nucleoli | (100) coarse, clumped chromatin |
or | or | or |
(2) nucleoli insignificant | (2) nucleoli insignificant | (10) fine to coarse chromatin |
or | or | or |
(1) no nucleoli | (1) no nucleoli | (1) uniform, fine chromatin |
(10) mitoses present | (1000) proeminent central necrosis - comedonecrosis | (10) evident nucleoli |
or | or | or |
(1) mitoses absent | (10) any confluent necrosis | (2) nucleoli insignificant |
or | or | |
(100) no true polarization of the cells with orientation toward a lumen | (1) no necrosis | (1) no nucleoli |
or | ||
(10) polarization present but not pronouced | (10) present mitoses | |
or | or | |
(1) all the cells have a well-defined apex and show polarization | (1) absent |
Statistical analysis
Results
Systems | Nuclear grade | Diagnostic scoring system | Subjective reading |
---|---|---|---|
n (%) | n (%) | ||
Black | Grade 1 | 12 (27.9) | 11 (25.6) |
Grade 2 | 10 (23.3) | 13 (30.2) | |
Grade 3 | 21 (48.8) | 19 (44.2) | |
Holland | Grade 1 | 2 (4.7) | 8 (18.6) |
Grade 2 | 19 (44.2) | 15 (34.9) | |
Grade 3 | 22 (51.2) | 20 (46.5) | |
Van Nuys | Group 1 | 17 (39.5) | 17 (39.5) |
Group 2 | 5 (11.6) | 9 (20.9) | |
Group 3 | 21 (48.8) | 17 (39.5) |
DCIS classification systems | Kappa values (κ ± EP) |
---|---|
Holland | 0.57 ± 0.10 |
Van Nuys | 0.67 ± 0.09 |
Black modificado | 0.67 ± 0.09 |
1-step disagreement | 2-step disagreement | |||||
---|---|---|---|---|---|---|
Super-estimateda
| Sub-estimateda
| Total | Super-estimateda
| Sub-estimateda
| Total | |
n (%) | n (%) | n (%) | n (%) | n (%) | n (%) | |
Holland | 8 (18.6) | 2 (4.6) | 10 (23.2) | 1 (2.3) | 0 (0.0) | 1 (2.3) |
Van Nuys | 5 (11.6) | 3 (7.0) | 8 (18.6) | 1 (2.3) | 0 (0.0) | 1 (2.3) |
Black | 5 (11.6) | 4 (9.3) | 9 (20.9) | 0 (0.0) | 0 (0.0) | 0 (0.0) |