Publication: Modifying the nuclear pleomorphism score in modified bloom richardson grading in invasive breast cancer
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Date
2021
Authors
Zain, Azam Hilmi Mohd
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Abstract
Background: The Modified Bloom Richardson System is the most used grading system for breast cancer. It evaluates three parameters: Mitotic activities, Tubular Formation, and Nuclear Pleomorphism. It has the problem of relying on subjective assessment, with poor inter-observer agreement and reproducibility, especially concerning nuclear pleomorphism. Newer methods to improve nuclear grading utilized increasingly sophisticated techniques. Our study is a pioneer study aimed to use simple, objective variables that have the potential to represent different degrees of nuclear pleomorphism and create a modified nuclear grading system using the selected variables. Methods: A retrospective study was done on 120 invasive breast cancer cases diagnosed between 2013 to 2017. For each case, one high magnification view (40x) of the most pleomorphic area is captured using a camera mounted on a microscope. The largest and smallest nucleus within the image is identified manually. The nuclear diameter was measured with the aid of image analyzer software. The variables obtained are tested using one-way ANOVA. Suitable variables were used to create the new nuclear scoring system. Validation of the new system was done using histopathology images created from 53 breast cancer cases diagnosed between 2018 to 2019. Results: Analysis of current nuclear grading on 120 samples show mild, moderate, and severe nuclear pleomorphism in 13, 80, and 27 cases, respectively. Two of the tested variables; ‘largest nuclei size’ and ‘nuclear size difference’ showed significant difference in mean between the three different nuclear grades (p <0.001). The modified nuclear grading is constructed using combination of the two variables and showed moderate agreement when compared to the current grading (kappa 0.367). Conclusion: Nuclear diameter is a potential variable to differentiate grades of nuclear pleomorphism. The new diameter-based scoring criteria has shown promising results. However, better model assessment will require further testing using larger samples.
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