**Note 1:** Leave Grade Post Therapy Clin (yc) blank when
* No neoadjuvant therapy
* Clinical or pathological case only
* Neoadjuvant therapy completed, no microscopic exam is done prior to surgery/resection of primary tumor
* There is only one grade available and it cannot be determined if it is clinical, pathological, post therapy clinical or post therapy pathological
**Note 2:** Assign the highest grade from the microscopically sampled specimen of the primary site following neoadjuvant therapy or primary systemic/radiation therapy.
**Note 3:** If there are multiple tumors with different grades abstracted as one primary, code the highest grade.
**Note 4:** Codes L and H take priority over A-D.
**Note 5:** Record the mitotic rate as Low or High as indicated on the pathology report or CAP protocol. Assume the denominator is 5 square mm if not specified.
* Low: 5 or fewer mitoses per 5 square mm (L)
* High: Over 5 mitoses per 5 square mm (H)
**Note 6:** Code 9 (unknown) when
* Microscopic exam is done after neoadjuvant therapy and grade from the primary site is not documented
* Microscopic exam is done after neoadjuvant therapy and there is no residual cancer
* Grade checked “not applicable” on CAP Protocol (if available) and no other grade information is available
**Note 7:** If you are assigning an AJCC Staging System stage group
* Grade is required to assign stage group
* Codes A-D are treated as an unknown grade when assigning AJCC stage group
* An unknown grade may result in an unknown stage group
