The Truth... What is it?


Introductory concepts
Same as for Elston system.

preparing a sample for grading
Same as for Elston system.


here are the grading parameters:

The "mSBR grade" (modified Scarf-Bloom-Richardson) is arrived at (by pathologists) by evaluating the cancer for the following two parameters in order to "sum" or add-up the designated points in order to produce an Arabic numerical sum score. Score ranges equate to Roman-numeral grades, there being four grades. MSBR stands for "modified Scarff-Bloom-Richardson method".

  • TUBULES: (a pattern or architectural parameter assessing cellular organization...the tumor's ability to maintain some semblance of normal bad the tissue organization looks)......not a factor in this system
  • NUCLEAR [size/shape] VARIATION: (a cytological/cellular bad the cells look [B-R grade here])
    1 point, if only mild nuclear enlargement, no/mild darkening of chromatin [nuclear DNA/chromosomes], no/mild variation of nuclear shapes and sizes.
    2 points, if moderate such changes.
    3 points, if nuclei quite large, or bizarre, or have prominent nucleoli, and are quite dark [hyperchromatic]
  • MITOTIC ACTIVITY: (a growth-rate parameter which is determined in the tumor area showing the fastest growth rate, usually the tumor periphery, counting the number of mitotic figures in ten high-power microscopic fields [hpf]...400x [40x objective and 10x ocular])
    1 point, 0-1 mitotic figures per 40x high-power field.
    2 points, 2 " " " " "
    3 points, 3 or more " " " "


now the assignment of grade

Now, having assigned the points for the two parameters, one simply adds them up and compares to the following list. For example: a tumor has moderate nuclear abnormalities (2 points), and 2 mitotic figures per hpf (2 points)...a total of 2 pt. plus 2 pt. equals a total 4 points. This assigning of numerical values adds a sort of discipline to the pathologist's estimations.

  • 2 total points is defined as mSBR Group I
  • 3 total points is defined as mSBR Group 2
  • 4 total points is defined as mSBR Group 3
  • 5 total points is defined as mSBR Group 4
  • 6 total points is defined as mSBR Group 5

Dr. Le Doussal, champion of this system, found that Groups 1-3 accounted for 33% of the total cases and had a distinctly lower risk for developing metastasis than even Groups 3 & 4. That is, patients with well differentiated tumors and low mitotic counts have an excellent prognosis.

commentary qualification
Same as for Elston system.

Some Official References

  1. Le Doussal V., et. al., Prognostic Value of Histological Grade Nuclear Components... Cancer [a journal] 64:1914-1921, 1989.
  2. Joensuu H, et. al., Late Mortality from..., Cancer [a journal]. 85:2183-2189,1999.
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(posted 3 December 2000)