Grade Pathological
This input is used for staging
Notes
**Note 1:** Grade Pathological must not be blank. **Note 2:** Assign the highest grade from the primary tumor. **Note 3:** If there are multiple tumors with different grades abstracted as one primary, code the highest grade. **Note 4:** Codes 1-4 take priority over A-D, L and H. **Note 5:** CNS WHO classifications use a grading scheme that is a "malignancy scale" ranging across a wide variety of neoplasms rather than a strict histologic grading system that can be applied equally to all tumor types. * Code the WHO grading system for selected tumors of the CNS as noted in the AJCC 8th edition Table 72.2 when WHO grade is not documented in the record + A list of the histologies that have a default grade can also be found in the *Brain/Spinal Cord* CAP Protocol in Table 1: *WHO Grading System for Some of the More Common Tumors of the CNS*, Table 2: *WHO Grading System for Diffuse Infiltrating Astrocytomas and Table* 3: *WHO Grading Meningiomas* https://www.cap.org/protocols-and-guidelines/cancer-reporting-tools/cancer-protocol-templates * For **benign tumors ONLY (behavior 0),** code 1 can be automatically assigned for all histologies + This was confirmed by the CAP Cancer Committee **Note 6:** Use the grade from the **clinical work up** from the primary tumor in different scenarios based on behavior or surgical resection * **Behavior** - Tumor behavior for the clinical and the pathological diagnoses are the same AND the clinical grade is the highest grade - Tumor behavior for clinical diagnosis is invasive, and the tumor behavior for the pathological diagnosis is in situ * **Surgical Resection** - Surgical resection is done of the primary tumor and there is no grade documented from the surgical resection - Surgical resection is done of the primary tumor and there is no residual cancer * **No surgical resection** - Surgical resection of the primary tumor has not been done, but there is positive microscopic confirmation of distant metastases during the clinical time frame **Note 7:** Code 9 (unknown) when * Grade from primary site is not documented * No resection of the primary site (see exception in Note 6, Surgical resection, last bullet) * Neo-adjuvant therapy is followed by a resection (see Grade Post Therapy Path (yp)) * Grade checked “not applicable” on CAP Protocol (if available) and no other grade information is available * Clinical case only (see Grade Clinical) * There is only one grade available and it cannot be determined if it is clinical, pathological, post therapy clinical or post therapy pathological| Code | Description |
|---|---|
| 1 | WHO Grade I : Circumscribed tumors of low proliferative potential associated with the possibility of cure following resection |
| 2 | WHO Grade II: Infiltrative tumors with low proliferative potential with increased risk of recurrence |
| 3 | WHO Grade III: Tumors with histologic evidence of malignancy, including nuclear atypia and mitotic activity, associated with an aggressive clinical course |
| 4 | WHO Grade IV: Tumors that are cytologically malignant, mitotically active, and associated with rapid clinical progression and potential for dissemination |
| L | Stated as "low grade" NOS |
| H | Stated as "high grade" NOS |
| A | Well differentiated |
| B | Moderately differentiated |
| C | Poorly differentiated |
| D | Undifferentiated, anaplastic |
| 9 | Grade cannot be assessed (GX); Unknown |