Background. Fine-needle aspiration cytology plays a major role in the primary diagnosis of breast carcinoma. Cytological grading of the smears can provide valuable prognostic information and aid in planning the management options. Aim. To evaluate various 3-tier cytological grading systems and to determine the best possible system which is reliable and objective for use in routine practice. Materials & Methods. 72 fine-needle aspiration smears of breast carcinomas were graded by two pathologists and compared with the histologic grading by Nottingham modification of Scarff-Bloom-Richardson method. Concordance and correlation studies were done. Kappa measurement of interobserver agreement was also done. Results. Robinson’s method showed a better correlation (77.7%) and substantial Kappa value of agreement with Bloom Richardson’s histological grading method in comparison to the other methods, closely followed by Fisher’s method. Fisher’s method showed better interobserver agreement (84.7%, ) compared to the other systems. Conclusions. Robinson’s method of cytological grading in fine-needle aspiration smears of breast carcinoma is simpler, multifactorial, and feasible, hence being preferable for routine use according to our study. 1. Introduction In India, breast cancer is the second most common malignancy in females, next to cervical cancer [1]. The study by Khanna et al. has shown increasing incidence in breast cancer, especially in the younger age group [2]. Early diagnosis and prompt therapy are important to increase the survival of the patients. Surgical biopsy specimens serve as the “gold standard” for validating the diagnostic criteria and the value of histological grading has been widely accepted [3]. Fine needle aspiration (FNA) cytology is used for the preoperative diagnosis of breast malignancies and its role in determining the prognosis is being studied by various authors. The National Cancer Institute, Bethesda, sponsored conference had also recommended that the tumour grading on FNA material should be incorporated in FNA reports for prognostication [4]. Black et al. in 1955 introduced the concept of nuclear grading, which was modified and applied in cytological smears by Fisher et al. [5, 6]. Numerous two-tier and three-tier systems have been proposed for the cytological grading of breast tumors, but no single system is currently adapted for use in the routine evaluation of cytological aspirates of breast carcinoma. In the present study, various three-tier cytological grading systems were studied and compared to arrive at a simple, effective,
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