V.3.7.4 Breast – Nottingham or Bloom-Richardson (BR) Score Grade

(Site: breast excluding lymphomas)

Use these instructions for cases diagnosed on or after 01/01/2014 only.

For cases diagnosed on or before 12/31/2013, see Section V.3.5.8

BR could also be referred to as:  Bloom-Richardson, modified Bloom-Richardson, BR, BR grading, Scarff- Bloom-Richardson, SBR grading, Elston-Ellis modification of Bloom-Richardson score, Nottingham modification of Bloom-Richardson score, Nottingham modification of Scarff-Bloom-Richardson, Nottingham-Tenovus grade, or Nottingham grade.

Coding Instructions:

• Code the tumor grade using the following priority order
1. BR scores 3-9
2. BR grade (low, intermediate, high)

BR score may be expressed as a range, 3-9. The score is based on three morphologic features:  degree of tubule formation/histologic grade, mitotic activity, nuclear pleomorphism/nuclear grade of tumor cells.  

• If a report uses words such as low, intermediate, or high rather than numbers, use the table below to code grade.
• If only a grade of 1 through 4 is given with no information on the score and it is unclear if it is a Nottingham or BR Grade, do not use the table below.  Continue with the next priority according to “Coding for Solid Tumors”, see Section V.3.7.2.
• Code the highest score if multiple scores are reported (exclude scores from tests after neoadjuvant therapy began). Examples: different scores may be reported on multiple pathology reports for the same primary cancer; different scores may be reported for multiple tumors assigned to the same primary cancer.

Nottingham or Bloom-Richardson (BR) Score/Grade

Note: This grading system is coded in a site-specific factor for the applicable CS schema.

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