AttendMe Owl Logo
AttendMe
Sign In
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.

Interactive Decision Tree

Mini Map

Algorithm Steps

  1. ▶
    Start

    Tumor Grading Assessment

    Apply appropriate grading system by tumor type

    1. ◆
      Decision

      Tumor Type

      Select appropriate grading system

      1. ●
        Action

        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
        1. ●
          Action

          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
          1. ●
            Action

            Synoptic Report

            CAP protocol elements

            • Histologic type (WHO)
            • Grade (tumor-specific system)
            • pTNM stage
            • Margins status
            • Lymphovascular invasion
            • Perineural invasion
      2. ●
        Action

        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
      3. ●
        Action

        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
      4. ●
        Action

        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
      5. ●
        Action

        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
      6. ●
        Action

        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
      7. ●
        Action

        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%

Guideline Source

AJCC Cancer Staging Manual 8th Edition & WHO Classification

DOI: 10.1007/978-3-319-40618-3View Guideline

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

Related Pathology Pathways

Bone Marrow Biopsy Systematic Interpretation

Diagnostic

Coagulation Disorder Workup Algorithm (ISTH)

Diagnostic

Critical Values Reporting Protocol (CAP)

Management

Flow Cytometry Immunophenotyping Interpretation

Diagnostic

Next steps

Finish the workflow by opening the most relevant calculator, then convert the session into a live account when you are ready.

Calculator

Body Mass Index

Weight classification based on height and weight

Open page

Compare

AttendMe.ai vs UpToDate

See how this pathway workflow compares against UpToDate.

Open page

Commercial

Start free

Run the pathway in a live AttendMe account with citations and tracked usage.

Start free

Related Resources

All Clinical PathwaysClinical CalculatorsAI Chat with Auto-Detection

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