What is the WHO classification of breast cancer?

Histological grading and pathological staging of breast cancer

The relationship between histological grade of tumor and prognosis of patients has long been concerned by oncologists. The degree of differentiation of breast cancer is closely related to the prognosis, but there are great differences in various grading standards. The histological grading of breast cancer is mainly evaluated from the following three aspects. 1. Degree of glandular duct formation.

2. Nuclear polymorphism.

3. Nuclear fission counting.

The following are different grading standards:

A.SBR classification standard

1. The degree of differentiation is estimated according to the ability to form glandular ducts or nipples: ① The whole tumor can be regarded as 1. (2) It is not easy to find 3 points. ③ The score between1and 3 is 2.

2. Polymorphism ① The score of nuclear regularity and similarity with mammary epithelium is 1. ② The nucleus is obviously irregular, and the megakaryon and abnormal nucleus score 3 points. ③ The score between1and 3 is 2.

3. The mitotic number (× 400) ① 110 HPF is1. ② 2/ 10 HPF is 2 points. ③& gt； 2/ 10 HPF is three points.

B. WHO classification criteria

1. Adenoduct formation ① >: 75% is 1. ② 10% ~ 75% is 2 points. ③& lt； 10% is 3 points.

2. Polymorphism of nuclei ① The size, regularity and shape of nuclei are consistent with 1. ② The moderate change in the shape and size of the nucleus is 2 points. ③ Significant changes in the shape and size of the nucleus were scored as 3 points.

3. The mitotic number (× 400) ① 0 ~ 5/ 10 HPF is 1. ② 6 ~ 10/ 10 HPF is 2 points. ③& gt； 1110 HPF is 3 points.

C. Classification criteria for diagnosis and treatment of common malignant tumors in China

1. There are many obvious glandular ducts, and the score is 1. ② Moderately differentiated glandular duct is 2 points. ③ The growth of cells in solid patches or strips is three points.

2. The size, shape and chromatin of the nucleus are irregular ① The consistency of the size, shape and chromatin of the nucleus is 1. ② Moderate nuclear irregularity is 2 points. ③ The nuclear polymorphism is 3 points.

3. Chromatin increase and mitosis (× 400) ① 110 HPF is1. ② 2 ~ 3/ 10 HPF is 2 points. ③& gt； 3/ 10 HPF is three points.

The scores determined by the three indicators of each standard are added together, and 3 ~ 5 is divided into Grade I (well differentiated), 6 ~ 7 is divided into Grade II (moderately differentiated), and 8 ~ 9 is divided into Grade III (poorly differentiated).

Significance of histological grading of breast cancer

The prognostic significance of histological grading of breast cancer has long been recognized by everyone. We studied 476 breast cancer patients who were followed up for more than 5 years. The results showed that the 5-year survival rates of patients with grade I, II and III were 82%, 63.4% and 49.5%, respectively, with significant differences (P

Histological grading is related to DNA proliferation index and DNA ploidy. Highly differentiated breast cancer has a low proliferation index, while poorly differentiated breast cancer has a high proliferation index. Flow cytometry confirmed that diploid breast cancer is often well differentiated, while aneuploid breast cancer is often poorly differentiated. Histological grading is also related to the expression of growth factor receptor and oncogene products. Epithelial growth factor receptor is usually expressed in grade III breast cancer, suggesting a poor prognosis. The expression of some oncogene products, such as C-erbb2, indicates poor prognosis and is usually expressed in grade III breast cancer.

Histological grading and classification of breast cancer are both pathological factors affecting the prognosis of breast cancer, and their histological grading and classification are more meaningful for judging the prognosis of patients.

Although histological grading and classification are independent prognostic factors, lymph node metastasis and tumor size are more important prognostic factors. In 1982, Ilaybiffle and Elston thought that three factors related to prognosis were ① tumor size (pathological measurement), ② histological lymph node staging and ③ histological grading, and obtained the formula of prognosis index in cox analysis: Prognostic index = 0.2× tumor size+lymph node staging+histological grading, the higher the prognosis index, the worse the prognosis, and later a large number of case analyses confirmed their prognosis.

Clinical staging of breast cancer

Stage 0: The axillary lymph nodes were not touched on the same side, and the tumor diameter was less than 2cm.

Stage ⅰ: ipsilateral axillary palpation showed active lymph nodes with or without metastasis, and the tumor was 2 ~ 5 cm in diameter.

Stage ⅱ: ipsilateral axillary lymph nodes fused into a mass and adhered to other tissues, and the tumor diameter was more than 5cm.

Stage ⅲ: ipsilateral supraclavicular, inferior or axillary lymph node metastasis or upper limb edema. Metastatic lymph nodes fuse and harden.

Stage Ⅳ: Metastasis in other distant sites.

Pathological classification

T primary tumor

TX primary tumor cannot be determined (such as resection).

No T0 primary tumor was detected.

In situ tumor

DCIS ductal carcinoma in situ

LCIS lobular carcinoma in situ

Papillary paget's disease without tumor

Note: paget's disease with mass is classified according to the mass size.

T 1 maximum tumor diameter ≤2cm.

T 1mic micro-invasive carcinoma, the maximum diameter ≤0. 1cm.

Maximum diameter of T 1a > > 0. 1cm, ≤ 0.5cm

Maximum diameter of T 1b > > 0.5cm, ≤ 1.0cm.

Maximum diameter of T 1c > > 1.0cm, ≤ 2.0cm.

T2 maximum diameter > > 2.0cm, ≤5.0cm

T3 maximum diameter > > 5.0cm

T4 No matter the size of the tumor, it directly invades the chest wall or skin (the chest wall includes ribs, intercostal muscles and serratus anterior muscles, but does not include pectoral muscles).

T4a invades the chest wall

T4b Breast skin edema (including orange peel degeneration), ulcer or satellite nodule on the affected side.

T4c T4a and T4b coexist.

T4d inflammatory breast cancer

N- regional lymph nodes

Unable to analyze Nx regional lymph nodes (for example, clearance)

There was no lymph node metastasis in N0 area.

N 1 ipsilateral axillary lymph node metastasis and mobility.

N2 ipsilateral axillary lymph nodes were fused with each other or fixed with other tissues; Or there is no clinical evidence of axillary lymph node metastasis, and there is clinically obvious internal mammary lymph node metastasis.

N2a ipsilateral axillary lymph nodes were fused with each other or fixed with other tissues.

In N2b, there is obvious internal mammary lymph node metastasis in clinic without evidence of axillary lymph node metastasis.

N3 ipsilateral subclavian lymph node metastasis; Or there is clinical evidence showing axillary lymph node metastasis and clinically obvious internal mammary lymph node metastasis; Or ipsilateral supraclavicular lymph node metastasis, with or without axillary lymph node metastasis or internal mammary lymph node metastasis

N3a ipsilateral subclavian lymph node metastasis and axillary lymph node metastasis

N3b ipsilateral internal mammary lymph nodes and axillary lymph nodes metastasis

N3c ipsilateral supraclavicular lymph node metastasis

PN regional lymph nodes

Lymph nodes in the pNx region (which was not included in the operation or has been removed in the past) cannot be analyzed.

There was no regional lymph node metastasis in pN0 histology, and the isolated tumor cells were not examined separately.

There was no regional lymph node metastasis in pN0(i-) histology, and its immunohistochemistry was negative.

PN0(i+) showed no regional lymph node metastasis in histology, positive in immunohistochemistry, and the tumor focus was ≤ 0.2 mm.

There was no regional lymph node metastasis in pN0(mol-) histology, and the molecular detection (RT-PCR) was negative.

There was no regional lymph node metastasis in pN0(mol+) histology, and the molecular detection (RT-PCR) was positive.

There is micrometastasis in pN 1mi, and the maximum diameter is > > 0.2mm and ≤ 2.0 mm

PN 1 ipsilateral 1 ~ 3 axillary lymph node metastasis, or internal mammary sentinel lymph node metastasis under microscope, but it is not obvious clinically.

PN 1a ipsilateral 1 ~ 3 axillary lymph node metastasis

There is metastasis in PN 1b breast sentinel lymph nodes under microscope, but it is not obvious in clinic.

PN 1c ipsilateral 1 ~ 3 axillary lymph node metastasis, microscopic ipsilateral internal mammary sentinel lymph node metastasis, but it is not obvious clinically.

PN24 ~ 9 axillary lymph node metastasis, or clinically obvious internal mammary lymph node metastasis without axillary lymph node metastasis.

There are 4 ~ 9 axillary lymph node metastases in PN2A, and at least one tumor is larger than 2.0 mm.

Clinically, PN2b has obvious intramammary lymph node metastasis, but no axillary lymph node metastasis.

PN3 has axillary lymph nodes above 10, or subclavian lymph nodes, or axillary lymph nodes with obvious ipsilateral intramammary lymph node metastasis clinically; Or more than 3 axillary lymph node metastasis with clinically negative internal mammary lymph node metastasis under microscope; Or ipsilateral supraclavicular lymph node metastasis

PN3a 10 or 10 axillary lymph node metastasis (at least one tumor focus > > 2.0mm), or subclavian lymph node metastasis.

More than PN3B axillary lymph node metastasis with clinically negative internal mammary lymph node metastasis under sentinel lymph node biopsy microscope.

PN3c ipsilateral supraclavicular lymph node metastasis

M distant metastasis

Whether Mx has distant metastasis cannot be evaluated.

M0 has no distant metastasis.

M 1 has distant metastasis.

Description:

Clinically obvious: it refers to the discovery through clinical physical examination or imaging examination (except lymphoscintigraphy);

PN classification is based on axillary lymph node dissection, with or without sentinel lymph node biopsy. If only sentinel lymph node biopsy is done and axillary lymph node dissection is not done afterwards, then sentinel lymph nodes are represented by (sn), such as PN0 (I+) (Sn);

Isolated tumor cells refer to single cells or small cell clusters smaller than 0.2mm, which are usually found by immunohistochemical or molecular techniques and identified by routine histology. Isolated tumor cells do not necessarily show metastatic activity, such as proliferation or interstitial reaction.

Clinically inconspicuous: refers to the situation that cannot be found by clinical physical examination or imaging examination (except lymphoscintigraphy).

Clinical stage

This is not M0.

Phase I T 1 N0 M0

Phase IIA T0 N 1 M0

T 1 N 1 M0

T2 is not M0.

Stage IIB T2 N 1 M0

T3 is not in M0.

Stage IIIA to N2 M0

T 1 N2 M0

T2·N2·M0

T3 N 1~2 M0