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Breast cancer prognostic classification in the molecular era: the role of histological grade

Emad A Rakha1, Jorge S Reis-Filho2, Frederick Baehner3, David J Dabbs4, Thomas Decker5, Vincenzo Eusebi6, Stephen B Fox7, Shu Ichihara8, Jocelyne Jacquemier9, Sunil R Lakhani10, José Palacios11, Andrea L Richardson12, Stuart J Schnitt13, Fernando C Schmitt14, Puay-Hoon Tan15, Gary M Tse16, Sunil Badve17 and Ian O Ellis1*

Author Affiliations

1 Department of Histopathology, Nottingham City Hospital NHS Trust, Nottingham University, Nottingham, UK

2 The Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, Fulham Road, London, UK

3 Department of Anatomic Pathology, University of California, San Francisco, CA, USA

4 University of Pittsburgh Medical Center, Pittsburgh, PA, USA

5 Breast-Screening-Pathology, Reference Centre Munster, Gerhard Domagk-Institute of Pathology, University Hospital Münster, Domagkstrasse 17, D-48149 Münster, Germany

6 Sezione Anatomia Istologia e Citologia Patologica 'M. Malpighi', Università-ASL Ospedale Bellaria, Via Altura 3, 40139 Bologna, Italia

7 Pathology Department, Peter MacCallum Cancer Centre, St Andrews Place, East Melbourne, Victoria 3002, Australia

8 Department of Pathology, Nagoya Medical Center 4-1-1 Sannomaru, Naka-ku, Nagoya Japan

9 Unité d'Anatomie et de Cytologie Pathologiques, Institut Paoli-Calmettes, Marseille, France

10 Molecular and Cellular Pathology, University of Queensland Centre for Clinical Research, School of Medicine and The Royal Brisbane & Women's Hospital, Brisbane, Australia

11 Servicio de Anatomía Patólogica, Hospital Universitario Virgen del Rocio, Avda. Manuel Siurot, s/n, 41013 Sevilla, Spain

12 Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA

13 Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA

14 Institute of Molecular Pathology and Immunology (IPATIMUP) and Medical Faculty, University of Porto, Porto, Portugal

15 Department of Pathology, Singapore General Hospital, Outram Road, Singapore 169608

16 Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Ngan shing Street, Shatin, Hong Kong

17 Departments of Pathology and Internal Medicine, Clarian Pathology Lab of Indiana University, 350 West 11th Street, CPL-4050, Indianapolis, IN 46202, USA

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Breast Cancer Research 2010, 12:207  doi:10.1186/bcr2607

Published: 30 July 2010

First paragraph (this article has no abstract)

Breast cancer is a heterogeneous disease with varied morphological appearances, molecular features, behavior, and response to therapy. Current routine clinical management of breast cancer relies on the availability of robust clinical and pathological prognostic and predictive factors to support clinical and patient decision making in which potentially suitable treatment options are increasingly available. One of the best-established prognostic factors in breast cancer is histological grade, which represents the morphological assessment of tumor biological characteristics and has been shown to be able to generate important information related to the clinical behavior of breast cancers. Genome-wide microarray-based expression profiling studies have unraveled several characteristics of breast cancer biology and have provided further evidence that the biological features captured by histological grade are important in determining tumor behavior. Also, expression profiling studies have generated clinically useful data that have significantly improved our understanding of the biology of breast cancer, and these studies are undergoing evaluation as improved prognostic and predictive tools in clinical practice. Clinical acceptance of these molecular assays will require them to be more than expensive surrogates of established traditional factors such as histological grade. It is essential that they provide additional prognostic or predictive information above and beyond that offered by current parameters. Here, we present an analysis of the validity of histological grade as a prognostic factor and a consensus view on the significance of histological grade and its role in breast cancer classification and staging systems in this era of emerging clinical use of molecular classifiers.