Utility of Nottingham’s Modification of Bloom-Richardson’s Grading as a Time Bound Predictive Prognostic Tool in Diagnosis of Breast Cancer

Abstract

BACKGROUNDThe breast cancer among women both in the developed and developing world is rampant, the assessment of grading system of carcinoma breast and its utility for better time-bound prognostification can significantly improve in predicting aggressive tendency of the breast cancer and also further help develop a therapeutic protocol.The aim of the study is to compare between the histopathological tumour grade with prognostic factors like age (based on menstrual status), tumour size, lymph node status and to establish histopathological grading (modified Bloom-Richardson's) as a time-bound prognostic indicator. MATERIALS AND METHODSThe present work was carried out in the histopathology and immunohistochemistry section of Department of Pathology, Jawaharlal Nehru Medical College and Acharya Vinoba Bhave Rural Hospital, Sawangi (M), Wardha, from January 2013 to July 2016. It was a prospective analytical study. A tota1 of 114 female patients presenting in the Outpatient Department of Surgery with lump in breast were included in the present study. All patients underwent modified radical mastectomy for tumour resection. Tumour masses and lymph nodes were subjected to routine H and E staining, then examined by senior pathologist. Comparisons were made between histopathology grades with patient age, tumour size and lymph node status. RESULTSThe study found that the breast carcinoma having an excellent correlation between the histopathologic grades and the wellestablished prognostic tools, i.e. tumour size, lymph node status, though age-based on menstrual status was insignificant statistically. The 'p' value was significant when correlation between histopathological grade, tumour size and lymph node status was done respectively, P=0.0001, S; P=0.0006, S, whereas the 'p' value was insignificant, i.e. P=0.18, NS when correlation between the histopathology grade and age was done. CONCLUSIONNottingham's modification of Bloom-Richardson histopathological grade being an excellent predictive prognostic tool should be continued for assessing the grades in breast cancer patients as well as be incorporated at the clinical level with the tumour size, nodal involvement, metastasis (TNM) staging of breast cancers.