Tumor Grading Assessment
Apply appropriate grading system by tumor type
All Pathways
PathologyDiagnostic
Tumor Grading & Staging Principles (WHO/AJCC)
Tumor Grading & Staging Principles (WHO/AJCC): Tumor Grading Assessment → Tumor Type → Breast Carcinoma → TNM Staging Components → Synoptic Report.
Pathway Overview
11 steps
Algorithm Steps
11 total
01Start 02Decision Tumor Type
Select appropriate grading system
03Action Breast Carcinoma
Nottingham (Elston-Ellis) Grade
- Tubule formation: 1-3 points
- Nuclear pleomorphism: 1-3 points
- Mitotic count: 1-3 points
- Grade 1: 3-5, Grade 2: 6-7, Grade 3: 8-9
04Action TNM Staging Components
AJCC 8th Edition principles
- T: Primary tumor size/extent
- N: Regional lymph node involvement
- M: Distant metastasis
- Stage grouping: I-IV
- Clinical (c) vs Pathologic (p) staging
05Action Synoptic Report
CAP protocol elements
- Histologic type (WHO)
- Grade (tumor-specific system)
- pTNM stage
- Margins status
- Lymphovascular invasion
- Perineural invasion
06Action Prostate Carcinoma
Gleason/ISUP Grade Group
- Pattern 3: Individual glands
- Pattern 4: Fused/cribriform
- Pattern 5: Sheets/necrosis
- Grade Group 1: 3+3=6
- GG2: 3+4=7, GG3: 4+3=7
- GG4: 4+4/3+5/5+3=8, GG5: 9-10
- Path rejoins step 04Shared downstream outcome
07Action Renal Cell Carcinoma
WHO/ISUP Nucleolar Grade
- Grade 1: Inconspicuous nucleoli at 400x
- Grade 2: Visible nucleoli at 400x, inconspicuous at 100x
- Grade 3: Visible nucleoli at 100x
- Grade 4: Extreme pleomorphism/sarcomatoid/rhabdoid
- Path rejoins step 04Shared downstream outcome
08Action Colorectal Carcinoma
Differentiation Grade
- Well diff (G1): >95% gland formation
- Moderate (G2): 50-95% glands
- Poorly diff (G3): <50% glands
- Undiff (G4): No gland formation
- Path rejoins step 04Shared downstream outcome
09Action GIST Risk Stratification
Miettinen/NIH criteria
- Size: <2cm, 2-5cm, 5-10cm, >10cm
- Mitotic rate: ≤5 or >5 per 5mm²
- Site: Gastric (lower risk) vs non-gastric
- Risk: Very low, Low, Intermediate, High
- Path rejoins step 04Shared downstream outcome
10Action Soft Tissue Sarcoma
FNCLCC Grade
- Differentiation: 1-3 points
- Mitotic count: 1-3 points
- Necrosis: 0-2 points
- Grade 1: 2-3, Grade 2: 4-5, Grade 3: 6-8
- Path rejoins step 04Shared downstream outcome
11Action Neuroendocrine Tumors
WHO 2019 Grade
- G1: Mitoses <2/10HPF, Ki-67 <3%
- G2: Mitoses 2-20/10HPF, Ki-67 3-20%
- G3: Well-diff, mitoses >20, Ki-67 >20%
- NEC: Poorly differentiated, Ki-67 >20%
- Path rejoins step 04Shared downstream outcome
Guideline Source
AJCC Cancer Staging Manual 8th Edition & WHO Classification
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Grading systems are tumor-type specific
- Does not include all tumor types
- Molecular grading increasingly important
- Inter-observer variability exists
- Some tumors have multiple grading systems
Applicable Regions
USAUUKEU
AU: RCPA structured reporting
UK: RCPath datasets
US: AJCC/CAP synoptic reporting
Version 1Next review: 2027-01-01
Next steps
Finish the workflow by opening the most relevant calculator, then convert the session into a live account when you are ready.
Related Resources
Frequently Asked Questions
What is the Tumor Grading & Staging Principles (WHO/AJCC)?
The Tumor Grading & Staging Principles (WHO/AJCC) is a diagnostic clinical algorithm for Pathology. It provides a structured decision tree to guide clinical decision-making, based on AJCC Cancer Staging Manual 8th Edition & WHO Classification.
What guideline is the Tumor Grading & Staging Principles (WHO/AJCC) based on?
This algorithm is based on AJCC Cancer Staging Manual 8th Edition & WHO Classification (DOI: 10.1007/978-3-319-40618-3).
What are the limitations of the Tumor Grading & Staging Principles (WHO/AJCC)?
Known limitations include: Grading systems are tumor-type specific; Does not include all tumor types; Molecular grading increasingly important; Inter-observer variability exists; Some tumors have multiple grading systems. Individual patient factors may require deviation from these recommendations.
Get AI-Powered Analysis Alongside This Algorithm
In AttendMe.ai, the Tumor Grading & Staging Principles (WHO/AJCC) appears automatically when your clinical question matches — alongside evidence from 3M+ peer-reviewed articles.
Try AttendMe Free