Background: Quantified grading of breast carcinoma through histologic analysis has been practiced for many years, but generally has not been used as an aid in treatment decision-making.
Methods: A representative sample of the literature is reviewed and discussed.
Results: The literature overwhelmingly confirms that histologic features suitable for grading provide important prognostic information at all stages of the disease, but there is no uniformly agreed on methodology for the application of this information. Disagreement still exists as to its validity and it is often ignored.
Conclusions: It appears reasonable that serious attempts be made to overcome the perceived problems with the grading of breast carcinoma and to develop a consensus regarding a methodology for quantifying this well established index of the virulence of the disease that is comparable to the consensus reached in the American Joint Committee on Cancer staging of the extent of disease. This information then could be used in the design of clinical trials. [See editorial counterpoint on pages 1703-5 and reply to counterpoint on pages 1706-7, this issue.]