Bloom-Richardson NUCLEAR GRADING

The ability to discern nuclear characteristics is significantly dependent on the type of fixative (as of 2010, 10% NBF is the only fixative for tissue that might be used for IHC or molecular studies...with pains taken to NOT over-fix or under-fix). One excellent fixative for other reasons, Hartmann's, destroys RBCs [red blood cells] which are the internal size ruler (an RBC is 6-7 microns wide in histological sections) for measuring nuclear size. In a given case, we might use different fixatives (10% neutral buffered formalin [10% NBF] or B5 or Hartmann's or M2, etc.) if there is enough specimen.

• tumor nuclei have diffuse chromatin, absent/inapparent nucleoli and average no larger than 1 to 1.5 RBC diameters:
  nuclear grade 1 (one point)
• tumor nuclei have coarse chromatin, present but infrequent nucleoli and average no larger than 1.5 to 2.0 RBC diameters:
  nuclear grade 2 (two points)
• tumor nuclei have vesicular chromatin, frequent nucleoli and average larger >2 RBC diameters:
  nuclear grade 3 (three points)

VNPI (for d-CIS) SCORE= tumor-size pts x 0.749 [_____] plus nuclear pts x 0.869 [_____]
plus margin pts x 0.864 [_____]=_____total VNPI points

[BACK TO VNPI PAGE] or to VNPI calculation table

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