Histological Grading, Staging and Nottingham Prognostic Index Scoring of Breast Carcinoma: A Hospital Based Observational Study

Abstract

Background and Aims: Breast cancer besides being a global cancer burden comprises a complex and heterogeneous group of diseases at clinical, morphological, and molecular levels. Among all the clinicopathological- molecular prognostic factors available in decision making about suitable treatment options for breast cancer, Nottingham prognostic index (NPI) is the most simple, powerful integrated and reproducible index. This study was aimed to evaluate the NPI in a group of breast cancer patients and to correlate NPI with other clinical and histomorphological features.
Material and Methods: A cross-sectional observational study of mastectomy specimens with axillary lymph node sampling was done for a period of three years. The diagnosis was made using WHO classification. Grading and staging was done using Modified Bloom Richardson score and TNM system respectively. The prognosis was scored by applying Nottingham Prognostic index.
Results: Out of the 63 patients, most belonged to the age group of 41 to 50 years. The most common histologic type was Invasive Carcinoma of No Special Type (49 cases; 77.78%). Majority of the patients (69.84%) belonged to Bloom Richardson (BR) Grade II. Lymph node biopsy was reviewed with 57.14% of the patients showing nodal metastasis. Significant correlation was noted between NPI score and tumor size, positive lymph nodes and BR grade. The mean NPI score was found to be 4.53 ± 1.04.
Conclusion: NPI serves as an essential and powerful prognostic indicator, relying on relatively simple data of primary tumour size, lymph node stage and histological grade which act as a hard copy for clinicians to decide treatment modalities for the patient and in follow up as well.