differentiation

[DazedandConfused]

I was reviewing your archives and came accros a message posted by TORE on Saturday, November 03, 2001.  In his message he discloses that the biopsy was 2 for tubule formation, 2 for nuclear grade and 1 for mitotic count for a total of 5/9.  He lists that the path report defined this as moderately differentiated.  He then askes how agressive is the tumor.  In your response, you define it as a moderately agressive tumor.  My neighbors path report is exactly the same (5/9) and her path classifies this as well diferrentiated.  I have also visited web sites on grading and they seem to indicate that 3-5 + well differentiated, 6-7 are moderate and 8-9 are poorly differentiated.  What gives?  did you make a mistake?

[CCF-RN,MSN-rf]

Dear DazedandConfused:  NO! There's no mistake.  You are comparing two different pieces of information, neither of which is, or should be, considered in isolation.  Cell differentiation describes how different the cells look from the normal cells.  Well differentiated cells tend to be less aggressive and poorly differentiated cells tend to be more aggressive.  And...moderately differentiated cells tend to be moderately aggressive.  This is the information on which the other answer was based.  The other data provided by the writer was the Bloom Richardson score - a score that combines a variety of factors to give a score.  The way it is quantified is 3-5 grade 1, 6-7 grade 2, and 8-9 grade 3.  The higher the score, the more aggressive the tumor is thought to be.  Since research has shown that pathologists viewing the same cancer agree on the Bloom Richardson score only 75% of the time, it is prudent to use more information than this score in isolation.  Given the other writer's cell differentiation of moderate and the very borderline Bloom Richardson score of 5, the tumor should be considered moderately aggressive.  In general, in cancer, it is safest to go with the most aggressive of the variables.  That way there is less risk undertreating someone.  I have attached the archived question for the benefit of others who may read your question.

Question Posted By: TORE on Saturday, November 03, 2001


My mom had a mammogram that showed a 8mm lesion - she had a core needle biopsy, we just received the path report, could you tell us what this all means?

Infiltrative Ductal Adenocarcinoma, 1.2 cm, Moderately Differentiated (Tubule Formation 2/3, Nuclear Grade 2/3, Mitotic Grade 1/3, For a Histologic Score of 5/9) with Focal Ductal Carcinoma in Situ (Solid and Cribriform). Margins of Excision Negative for Malignancy.

Is this really aggressive? How did it go from 8mm on the mammo to 1.2 cm so quick? What treatment will be necessary?

She has to have a Sentinol Node Biopsy next week. This is all so horifying - all the waiting, etc. Thank you.

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Answer Posted By: CCF-RN,MSN-RF on Monday, November 05, 2001

Dear TORE: From what you write, it sounds as though your mom had an excisional biopsy - the tumor has been removed. I doubt if the tumor grew. I would imagine that the view on the mammogram simply did not detect the largest dimension. Remember, its a difference of 4mm which is very small. Also, in the setting of breast cancer, 1.2cm is still considered a small tumor. Based on the pathology, this is a moderately aggressive tumor. The good news is that the margins (or edges of the surgery) are negative - that means no more breast surgery other than the lymph node excision. Treatment will be determined by several factors, including lymph node status, estrogen/progesterone receptor status, as well as the opinion of the physician. Without knowing more, the only treatment I would commit to would be radiation therapy, since she had a lumpectomy only. If she were to have a mastectomy, no radiation therapy would likely be necessary.

[DazedandConfused]

Sorry about the typos.  I was in a rush.