A single pathological grading system for breast carcinoma should be adopted in Sri Lanka.

ABSTRACT

INTRODUCTION: Histologic grading of breast cancer is related to prognosis and management of patients. The grading systems used are the initially formulated subjective methods, and the more recently described objective Nottingham system. In Sri Lanka there is lack of uniformity in histopathology reporting of breast cancer. All methods used employ 3 grades. If histologic grading is to be of clinical relevance, it is important that the grades of different systems correlate with one another. OBJECTIVE: To determine if the three grades of the Nottingham system correlate with those of the other systems. SETTING: Department of Pathology, Faculty of Medicine, Colombo. METHOD: 54 breast carcinomas were graded using the Nottingham system by reviewing histology slides. The Nottingham grading was compared with the original grading mentioned in the histology report. RESULTS: The original reports included 35 tumours graded with systems other than Nottingham. 45.7% of these tumours did not correspond with the subsequent Nottingham grade. 40% had to be upgraded from grade II to III. When the 19 tumours originally graded using the Nottingham system were re-evaluated using the same system, there was concurrence in 89.5% of the cases. CONCLUSION: Our results indicate a failure of other grading systems to correlate with the corresponding Nottingham grade in a high proportion of cases. We recommend the adoption of a single, objective grading system such as the Nottingham method by all clinicians in Sri Lanka.