Correlation Of Various Cytological Grading Systems With Histopathological Grading In Breast Carcinoma

  • Vijayalaxmi S Patil Department of Pathology, BLDE University’s Shri B.M.Patil Medical College, Vijayapura-586103 Karnataka State, India.
  • Surekha B Hippargi Department of Pathology, BLDE University’s Shri B.M.Patil Medical College, Vijayapura-586103 Karnataka State, India.
  • Raga Sruthi Dwarampudi Department of Pathology, BLDE University’s Shri B.M.Patil Medical College, Vijayapura-586103 Karnataka State, India.
  • Lynda Rodrigues Department of Pathology, BLDE University’s Shri B.M.Patil Medical College, Vijayapur-586103 Karnataka State, India.
Keywords: Carcinoma breast, Cytological grading, Scarff Bloom Richardson grading


Background: The nuclear grading of breast carcinoma is well established on histopathology, but not in cytology. There is no single standardised grading system yet in cytology for predicting breast carcinoma prognosis in spite of various cytological grading systems.Aim: The study was performed with an aim of evaluating various cytological grading systems on needle aspirates of breast carcinoma and to determine the best possible cytological grading system that correlates with the Nottingham modification of Scarf Bloom Richardson(SBR) histological grading.Materials & Methods: The study consisted of 30 cases of infiltrating ductal carcinoma diagnosed on cytology for which the corresponding histopathology was available. These cases were graded cytologically by eight grading systems and histologically by SBR method. The various cytological grading systems were evaluated for concordance, association, and correlation with the histopathological grading to select best possible cytological grading system. The various grading systems were also evaluated for interobserver reproducibilityResults:  A positive correlation was noted between the various grading systems on cytology with SBR method on histopathology. A strong correlation (r =0.925), maximum percent agreement (93.3%), and a substantial kappa value of agreement (k = 0.885) was noted for Robinson’s grading with the Nottingham modification of SBR grading system. It also showed better interobserver agreement (93.3%; k = 0.889).Conclusion: The various cytological grading systems evaluated in this study showed a positive correlation with SBR method. Among them, Robinson’s grading showed best concordance, correlation with histological grade and hence, may be included in the routine cytology reports.DOI:10.21276/APALM.1837


1.Arul P, Masilamani S. Comparative evaluation of various cytomorphological grading systems in breast carcinoma. Indian J Med Paediatr Oncol 2016;37:79-84.

2. Phukan JP, Sinha A, Deka JP. Cytological grading of breast carcinoma on fine needle aspirates and its relation with histological grading. South Asian J Cancer 2015;4(1): 32–34.

3. Pandey P, Dixit A, Chandra A, Kaur S. A Comparative and Evaluative Study of Two Cytological Grading Systems in Breast Carcinoma with Histological Grading: An Important Prognostic Factor. Anal Cell Pathol (Amst). 2014;2014:767215. doi: 10.1155/2014/767215. Epub 2014 Dec 8

4. Sinha SK, Sinha N, Bandyopadhyay R, Mondal SK. Robinson’s cytological grading on aspirates of breast carcinoma: Correlation with Bloom Richardson's histological grading.
J Cytol. 2009; 26(4): 140–143.

5. Pal S, Gupta L. Correlation between cytological and histological grading of breast cancer and its role in prognosis. J Cytol 2016;33:182-6.

6. Einstien D, Omprakash BO, Ganapathy H, Rahman S. Comparison of 3-tier cytological grading systems for breast carcinoma. ISRN Oncol. 2014 Mar 12;2014:252103. doi: 10.1155/2014/252103. eCollection 2014.

7. Robinson IA, McKee G, Nicholson A, D’Arcy J, Jackson PA, Cook MG, et al. Prognostic value of cytological grading of fine-needle aspirates from breast carcinomas. Lancet 1994;343:947-49.

8. Mouriquand J, Pasquier D. Fine needle aspiration of breast carcinoma: A preliminary cytoprognostic study. Acta Cytol 1980;24:153-59.

9. Mouriquand J, Gozlan-Fior M, Villemain D, Bouchet Y, Sage JC, Mermet MA, et al. Value of cytoprognostic classification in breast carcinomas. J Clin Pathol 1986;39:489-96.

10. Taniguchi E, Yang Q, Tang W, Nakamura Y, Shan L, Nakamura M, et al. Cytologic grading of invasive breast carcinoma. Correlation with clinicopathologic variables and predictive value of nodal metastasis. Acta Cytol 2000; 44:587-91.

11. D. J. Dabbs and J. F. Silverman, “Prognostic factors from the fine-needle aspirate:breast carcinoma nuclear grade. DiagnosticCytopathology 1994;10(3):203–08.

12. Rekha TS, Nandini M, Murali Dhar. Expansion of Masood’s Cytologic Index for breast carcinoma and its validity. Journal of Cytology 2013;30(4):233-36.

13. Fisher ER, Redmond C, Fisher B. Histologic grading of breast cancer. Pathol Annu. 1980;15(Pt 1):239-51.

14. Khan MZ, Haleem A, Al Hassani H, Kfoury H. Cytopathological grading, as a predictor of histopathological grade, in ductal carcinoma (NOS) of breast, on air-dried Diff-Quik smears. Diagn. Cytopathol. 2003;29:185-93.

15. Howell LP, Gandour-Edwards R, O’Sullivan D. Application of the Scarff-Bloom-Richardson tumor grading system to fine-needle aspirates of the breast. Am J Clin Pathol 1994; 101:262-65.

16. Bansal C, Pujani M, Sharma KL, Srivastava AN, Singh US. Grading systems in the cytological diagnosis of breast cancer: A review. J Can Res Ther 2014;10:839‑45.

17. Saha K, Raychaudhuri G, Chattopadhyay BK, Das I. Comparative evaluation of six cytological grading systems in breast carcinoma. J Cytol 2013;30:87-93.

18. Zoppi JA, Pellicer EM, Sundblad AS. Cytohistologic correlation of nuclear grade in breast carcinoma. Acta Cytol 1997;41:701-04.

19. A.K.Das, K.Kapila, A. K.Dinda,K.Verma. Comparative evaluation of grading of breast carcinomas in fine needle aspirates by two methods. Indian Journal of Medical Research 2003;118:.247–250.

20. Bhargava V, Jain M, Agarwal K, Thomas S, Singh S. Critical appraisal of cytological nuclear grading in carcinoma of the breast and its correlation with ER/PR expression. J Cytol 2008;25:58-61.

21. Chhabra S, Singh PK, Agarwal A, Bhagoliwal A, Singh SN. Cytological grading of breast carcinoma: A multivariate regression analysis. J Cytol 2005;22:62-65.

22. Meena SP, Hemrajani DK, Joshi N. A comparative and evaluative study of cytological and histological grading system profile in malignant neoplasm of breast — An important prognostic factor. Indian J Pathol Microbiol 2006;49:199-202.

23. Lingegowda JB, MuddeGowda PH, Ramakantha CK, Chandrasekar HR. Cytohistological correlation of grading in breast carcinoma. Diagn. Cytopathol. 2011;39:251-57.

24. L.W.Dalton, D.L.Page, W.D.Dupont. Histologic grading of breast carcinoma:a reproducibility study.Cancer 1994;73:2765–2770.

25. Mridha AR, Iyer VK, Kapila K, Verma K. Value of scoring system in classification of proliferative breast disease on fine needle aspiration cytology. Indian J Pathol Microbiol 2006;49:334-40.
Original Article