Explain Pathology Report

The biopsy results said "InfiltrATING DUCTAL ADENOCARCINOMA, ELSTON'S GRADE 2, SCORE 6 (TUBLES 3,MITOSIS 1,NUCLEAR PLEMORPHISM 2) 1.5CM IN DIA AJCC STAGE 1 (T1c,NX,MX) INVOLVING A FINAL INKED RESECTION MARGIN.  Ductal carcinoma in situ, cribriform type with low grade nuclear festures outside of the invasive component. Also notation that regional lymph nodes and distant metastasis cannot be assessed. The doctor is recommending a mastectomy, removal of lymph nodes and chemo.

What do all the letters and numbers mean? Particularly Grade 2 Score 6.  What are low grade nuclear festures?

Tissue removed was 6X5X2 cm. Are there other tests that I should have completed before taking such drastic measures?  I have a mammogram every year and this just appeared.  I am 57 years old and have been taking Premerin since my hysterectomy in 1985.

[CCF-RN,MSN-JS]

Dear Koi, "Elston grade 2" is a score obtained from a tumor rating scale that the pathologist uses to describe what they are seeing under the microscope.  There are various features (tubules, mitosis, nuclear pleomorphism) that are scored and the total is obtained to give the total score or grade. Elston refers to the type of scale used "Elston Modified Bloom Richardson" scale.  A total score of 3-5=grade 1,6-7=grade 2, and 8-9=grade 3.  Grade 3 is the highest and supposedly the most aggressive.

The surgeon uses the results from the biopsy to make recommendations for further treatment.  At this point this information is enough to proceed with recommendations for surgery.  They would want to check your lymph nodes (that involves further surgery), and get clean margins.  Ask about lumpectomy followed by radiation therapy - if that is a possiblility in your situation.  

The current standard of care is to offer adjuvant chemotherapy (Adjuvant treatment is given after surgery to try to prevent or minimize the growth of microscopic deposits of tumor cells that might grow into a recurrent tumor) if the tumor is greater than 1 cm in size regardless of the lymph node status.  Lymph nodes are still checked in order to properly stage the disease.