THE MSBR
BREAST CANCER GRADING SYSTEM
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 ScarfBloomRichardson)
is arrived at (by pathologists) by evaluating the cancer for the following two parameters in
order to "sum" or addup the designated points in order to produce an Arabic numerical sum
score. Score ranges equate to Romannumeral grades, there being four grades. MSBR stands for
"modified ScarffBloomRichardson method".
 TUBULES: (a pattern or architectural parameter assessing cellular
organization...the tumor's ability to maintain some semblance of normal order...how bad
the tissue
organization looks)......not a
factor in this system
 NUCLEAR [size/shape] VARIATION: (a cytological/cellular
parameter...how bad the cells look [BR 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 growthrate 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
highpower microscopic fields [hpf]...400x [40x objective and 10x ocular])
1 point, 01 mitotic figures per 40x highpower 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 13 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
 Le Doussal V., et.
al., Prognostic Value of Histological Grade Nuclear Components...
Cancer [a journal] 64:19141921, 1989.
 Joensuu H, et. al.,
Late Mortality from..., Cancer [a journal].
85:21832189,1999.
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(posted 3 December 2000)
