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Nottingham histological grade

Grades invasive breast carcinoma as 1, 2 or 3 by summing tubule formation, nuclear pleomorphism and mitotic count.

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Check the population, units and version. The result shows the formula or classification; it does not make an automatic treatment decision.

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Method · Limits of application

Nottingham/Elston–Ellis 1991: 3 components 1–3, total 3–9; mitoses per field area

Histopathological grading of breast carcinoma by tubule formation, pleomorphism and mitoses. Mitotic thresholds depend on the microscope field area. The grade is not the Nottingham Prognostic Index and does not replace pathological assessment or validate another histology.

Conditions of use

Check the population, units, inclusion and exclusion criteria, and version in the original source. A result alone does not establish a diagnosis, discharge decision or prescription.

Documented parameters

Tubule/gland formation
Nuclear pleomorphism
Mitotic count (in 10 fields, adjusted for field diameter)

3/3 reference cases checked. Numerical tests are not clinical validation.

Sources and documentation

Documented formula

Transcribed from the source or a recorded revision; this is not a clinical recommendation.

Each component scores 1 to 3 points. Sum 3–5 = grade 1 · 6–7 = grade 2 · 8–9 = grade 3.

The mitotic-count threshold depends on microscope high-power-field area; use the source conversion table or local service protocol.

References

Elston CW, Ellis IO. Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology, 1991.

Identifier: nottingham

Original clinical content: Brazilian Portuguese.

Method version

Nottingham/Elston–Ellis 1991: 3 components 1–3, total 3–9; mitoses per field area

nottingham@native-2026-10-03+be58698417cc

Source for the active edition

The bibliographic edition identifies the source. By itself, it proves neither full conformity of the formula nor clinical approval.

Synthetic cases checked (3)

Synthetic cases for checking the implementation, with no patient data.

Case 1

reference-001

Inputs

Tubule/gland formation: > 75% of the tumor
Nuclear pleomorphism: Small, regular and uniform nuclei
Mitotic count (in 10 fields, adjusted for field diameter): Score 1 (low)

{
  "tubulos": "1",
  "nucleo": "1",
  "mitoses": "1"
}

Expected result

{
  "score": 3,
  "level": "low",
  "verdict": "Grau 1"
}

Actual result

{
  "score": 3
}

Case 2

reference-002

Inputs

Tubule/gland formation: < 10%
Nuclear pleomorphism: Moderate increase in size and variability
Mitotic count (in 10 fields, adjusted for field diameter): Score 1 (low)

{
  "tubulos": "3",
  "nucleo": "2",
  "mitoses": "1"
}

Expected result

{
  "score": 6,
  "level": "mid",
  "verdict": "Grau 2"
}

Actual result

{
  "score": 6
}

Case 3

reference-003

Inputs

Tubule/gland formation: < 10%
Nuclear pleomorphism: Marked variation
Mitotic count (in 10 fields, adjusted for field diameter): Score 2 (intermediate)

{
  "tubulos": "3",
  "nucleo": "3",
  "mitoses": "2"
}

Expected result

{
  "score": 8,
  "level": "high",
  "verdict": "Grau 3"
}

Actual result

{
  "score": 8
}

Code and reproducibility

This tool’s code on GitHub

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Sources, version and reproduction instructions

The code tests are technical checks. Clinical approval and professional translation review are recorded separately.

Relationship with cancer research

Specific oncological application

Histological grading of invasive breast carcinoma from pathological criteria. It does not estimate individual treatment benefit.

Applications: Biomarkers