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{
"id" : "grade_clinical_91491",
"algorithm" : "eod_public",
"version" : "1.0",
"name" : "Grade Clinical",
"title" : "Grade Clinical",
"notes" : "**Note 1:** Clinical grade must not be blank.\n\n**Note 2:** Assign the highest grade from the primary tumor assessed during the clinical time frame. \n\n**Note 3:** Priority order for codes\n* Invasive cancers: codes 1-3 take priority over A-D. \n* In situ cancers: codes L, M, H take priority over A-D\n\n**Note 4:** Scarff-Bloom-Richardson (SBR) score is used for grade. SBR is also referred to as: Bloom-Richardson, Nottingham, Nottingham modification of Bloom-Richardson score, Nottingham modification, Nottingham-Tenovus grade, or Nottingham score. \n\n**Note 5:** All invasive breast carcinomas should be assigned a histologic grade. The Nottingham combined histologic grade (Nottingham modification of the SBR grading system) is recommended. The grade for a tumor is determined by assessing morphologic features (tubule formation, nuclear pleomorphism, and mitotic count), assigning a value from 1 (favorable) to 3 (unfavorable) for each feature, and totaling the scores for all three categories. A combined score of 3–5 points is designated as grade 1; a combined score of 6–7 points is grade 2; a combined score of 8–9 points is grade 3.\n* Do not calculate the score unless all three components are available\n\n**Note 6:** Code 9 when\n* Grade from primary site is not documented\n* Clinical workup is not done (for example, cancer is an incidental finding during surgery for another condition)\n* Grade checked “not applicable” on CAP Protocol (if available) and no other grade information is available\n\n**Note 7:** If there is only one grade available and it cannot be determined if it is clinical, pathological, or after neo-adjuvant therapy, assign as a clinical grade and code unknown (9) for pathological grade, and blank for post-therapy grade. \n\n**Note 8:** If you are assigning an AJCC 8th edition stage group\n* Grade is required to assign stage group\n* Codes A-D are treated as an unknown grade when assigning AJCC stage group \n* An unknown grade may result in an unknown stage group",
"last_modified" : "2018-03-12T16:39:56.435Z",
"definition" : [ {
"key" : "grade_clin",
"name" : "Code",
"type" : "INPUT"
}, {
"key" : "description",
"name" : "Description",
"type" : "DESCRIPTION"
} ],
"rows" : [ [ "1", "G1: Low combined histologic grade (favorable), SBR score of 3–5 points" ], [ "2", "G2: Intermediate combined histologic grade (moderately favorable); SBR score of 6–7 points" ], [ "3", "G3: High combined histologic grade (unfavorable); SBR score of 8–9 points" ], [ "L", "Nuclear Grade I (Low) (in situ only)" ], [ "M", "Nuclear Grade II (interMediate) (in situ only)" ], [ "H", "Nuclear Grade III (High) (in situ only)" ], [ "A", "Well differentiated" ], [ "B", "Moderately differentiated" ], [ "C", "Poorly differentiated" ], [ "D", "Undifferentiated, anaplastic" ], [ "9", "Grade cannot be assessed (GX); Unknown" ] ]
}
