Description

Stalsberg and Harmann described features of an infiltrating tubular carcinoma of the breast associated with a very low risk of nodal or distant metastasis. This can help identify patients with a good prognosis who can be managed more conservatively. The authors are from the University of Tromso in Norway and Vanderbilt University in Nashville.


 

Parameters:

(1) percent tubularity

(2) nuclear grade (Grades 1, 2, or 3)

(3) mitotic activity per high powered field (HPF) with an area of 0.15 square mm

 

percent tubularity =

= (number of cells bordering on a tubular lumen) / (total number of tumor cells)

 

In a tumor with 100% tubularity, all tumor cells border on a tubular lumen. This implies tubules formed of a single layer of cells. As the layers of cells increase or solid areas appear then the percent decreases. The authors demonstrate this with illustrations and photographs on page 602.

Nuclear Features

Nuclear Grade

minimal atypia

1

mild to moderate atypia

2

marked atypia

3

 

 

Mitotic Activity

Mitotic Grade

< 2 per HPF

1

2 - 3 per HPF

2

> 3 per HPF

3

 

Criteria for excellent prognosis group (no nodal metastases and no tumor deaths):

(1) percent tubularity >= 70%

(2) nuclear grade purely/uniformly Grade 1 (no Grade 2 or 3)

(3) mitotic activity Grade 1 (rare)

 

Criteria for good prognosis group (nodal metastases occur but no tumor deaths):

(1) percent tubularity >= 70%

(2) nuclear grade shows occasional Grade 2 nuclei

(3) mitotic activity Grade 2 (occasional)

 

Breast cancer deaths occur in woman where the percent tubularity is < 70%.

 


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