DCIS: The LAGIOS Grading System

Dr. Michael Lagios [pronounced Lay-os] is a pathologist in San Francisco who has for decades thoroughly and personally studied the breast cancers in his practice . His system is unusual in that the grades are in ascending Roman numerals from worst to best (almost all other cancer grading systems ascend from best to worst). The data in the table below are all relative to cases treated by CBS lumpectomy only and do not consider a margin parameter. Three parameters are noted: architectural features (histological subtype), Bloom-Richardson nuclear grade, and presence or absence of "comedo-type necrosis" [linear necrosis within central portions of neoplastic ducts].

DCIS
Histological
subtype Definition local recurrence risk
after CBS only
recurrence per total of subtype
grade I comedo high nuclear grade
solid growth pattern
+++ necrosis (comedo) 7/31 (23%)
grade II cribriform papillary
with necrosis high nuclear grade
cribriform/papillary architecture
+++ necrosis (comedo) 2/5 (40%)
grade III cribriform/
intermediate intermediate nuclear grade
cribriform architecture
+/- necrosis (punctate) 1/10 (10%)
grade IV micropapillary
(non-necrotic cribriform) low nuclear grade
micropapillary/cribriform architecture
zero necrosis 0/33 (0%)

reference: Surg. Clinics N. A., 70 (4), August 1990.

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(posted 18 Dec. 2000)