Grade Post Therapy Clin (yc) (Breast)

Note 1 Leave Grade Post Therapy Clin (yc) blank when

• No neoadjuvant therapy
• Clinical or pathological case only
• Neoadjuvant therapy completed, no microscopic exam is done prior to surgery/resection of primary tumor
• There is only one grade available and it cannot be determined if it is clinical, pathological, post therapy clinical or post therapy pathological

Note 2 Assign the highest grade from the microscopically sampled specimen of the primary site following neoadjuvant therapy or primary systemic/radiation therapy.

Note 3 If there are multiple tumors with different grades abstracted as one primary, code the highest grade.

Note 4 Priority order for codes

• Invasive cancers codes 1-3 take priority over A-D.
• In situ cancers codes L, M, H take priority over A-D

Note 5 Scarff-Bloom-Richardson (SBR) score is used for grade. SBR is also referred to as Bloom-Richardson, Nottingham, Nottingham modification of Bloom-Richardson score, Nottingham modification, Nottingham-Tenovus grade, or Nottingham score.

Note 6 All invasive breast carcinomas should be assigned a histologic grade. The Nottingham combined histologic grade (Nottingham modification of the SBR grading system) is recommended. The grade for a tumor is determined by assessing morphologic features (tubule formation, nuclear pleomorphism, and mitotic count), assigning a value from 1 (favorable) to 3 (unfavorable) for each feature, and totaling the scores for all three categories. A combined score of 3–5 points is designated as grade 1; a combined score of 6–7 points is grade 2; a combined score of 8–9 points is grade 3.

• Do not calculate the score unless all three components are available

Note 7 Code 9 (unknown) when

• Microscopic exam is done after neoadjuvant therapy and grade from the primary site is not documented
• Microscopic exam is done after neoadjuvant therapy and there is no residual cancer
• Grade checked “not applicable” on CAP Protocol (if available) and no other grade information is available

Note 8 If you are assigning an AJCC 8th edition stage group

• Grade is required to assign stage group
• Codes A-D are treated as an unknown grade when assigning AJCC stage group
• An unknown grade may result in an unknown stage group