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Morphological tumour differentiation has been shown in numerous studies to give a good prediction of prognosis in breast cancer. In the Nottingham/Tenovus study, tumour differentiation (histological grade) is assessed as part of a routine analysis of potential prognostic factors. Three features are analysed, the degree of tubule formation, variation in the size and shape of nuclei and mitotic rate. Each feature is given a score of 1-3 and grade is assigned as follows: Grade I, well differentiated, 3-5 points; Grade II, moderately differentiated, 6-7 points; Grade III, poorly differentiated, 8-9 points. Histological grade has been assessed in 625 patients with primary breast carcinoma and there is a strong correlation with prognosis; patients with well differentiated tumours have a significantly better survival than those with poorly differentiated tumours (P less than 0.0005). Grade forms an important part of the Nottingham/Tenovus prognostic index together with tumour size and lymph node stage. It is suggested that factors such as these should be used to stratify patients for appropriate therapy.
C.W. Elston (Wed,) studied this question.