Prognostic role of robinson cytological grading system in breast cancer in correlation with the histological grading of modified bloom richardson in Iraq


  • Noora M. Kareem Department of Pathology and Forensic Medicine, College of Medicine, Al-Nahrain University, Baghdad, Iraq
  • Nihad Salih Rahmatullah Department of Pathology, Al-Emamain Al-Kadhimain Medical City, Baghdad, Iraq



Breast carcinoma, Bloom richardson, Ductal carcinoma, Elston, FNA of breast, Robinson grading


Background: The breast cancer is increasing in developing countries and the management options are widened, therefore providing the surgeon with accurate prognostic information on which the mode of therapy will be chosen became so important. Robinson grading system was found to be useful in grading breast carcinoma in fine needle aspirates. The objectives of the study were to estimate the benefits of using Robinson grading system in fine needle aspiration for breast cancer and to estimate the correlation of Robinson grading system in fine needle aspiration with histological grading.

Methods: There were Seventy cases of invasive ductal carcinoma was graded on FNA aspirates by Robinson grading system using six cytological parameters (cell dissociation, cell size, cell uniformity, nucleolus, nuclear margin, and nuclear chromatin).

Results: The concordance rate between grade I tumors on cytology and histology was 100%, while for grade II tumors it was 62.5% and for grade III tumors it was 100%. The absolute concordance rate was 87.5%, the Spearman rank correlation coefficient (r) was 0.762, p value was (0.00), the sensitivity of Robinson’s cytological grading system in cytological grade I tumors was 73.33% and specificity was 100%. In cytological grade II tumors the sensitivity was 100% and specificity was 76% and in cytological grade III tumors the sensitivity is 100% and specificity was 100%.

Conclusions: Robinson’s cytological grading of breast carcinoma correlates well with Bloom-Richardson’s histological grading system and could be a helpful parameter in selecting a neoadjuvant treatment for the breast cancer patients on fine needle aspiration cytology alone.


Bansal C, Pujani M, Sharma KL, Srivastava AN, Singh US. Grading systems in the cytological diagnosis of breast cancer: A review. J Cancer Res Ther. 2014;10(4):839-45.

Youlden DR, Cramb SM, Yip CH, Baade PD. Incidence and Mortality of Female Breast Cancer in the Asia-Pacific Region. Cancer Biol Med. 2014;11(2):101-15.

Alghamdi IG, Hussain II, Alghamdi MS, El-Sheemy MA. The incidence rate of female breast cancer in Saudi Arabia: an observational descriptive epidemiological analysis of data from Saudi Cancer Registry 2001 – 2008. Breast Cancer Targets Ther. 2013;(5):103-9.

Mousavi SM, Montazeri A, Mohagheghi MA, Jarrahi AM, Harirchi I, Najafi M, et al. Breast cancer in Iran: An epidemiological review. Breast J. 2007;13(4):383-91.

Hirko KA, Soliman AS, Hablas A, Seifeldin IA, Ramadan M, Banerjee M, et al. Trends in breast cancer incidence rates by age and stage at diagnosis in gharbiah, Egypt, over 10 years (1999-2008). J Cancer Epidemiol. 2013;2013.

Elston CW, Ellis IO. Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopath. 1991;19(5):403-10.

Robinson IA, McKee G, Nicholson A, Jackson PA, Cook MG, D’Arcy J, et al. Prognostic value of cytological grading of fine-needle aspirates from breast carcinomas. Lancet. 1994;343(8903):947-9.

Elston CW, Ellis IO, Pinder SE. Pathological prognostic factors in breast cancer. Crit Rev Oncol Hematol. 1999;31(3):209-23.

Arul P, Masilamani S. Comparative evaluation of various cytomorphological grading systems in breast carcinoma. Indian J Med Paediatr Oncol. 2016;37(2):79.

Pal S, Gupta M. Correlation between cytological and histological grading of breast cancer and its role in prognosis. J Cytol. 2016;33(4):182.

Al-Hashimi MMY, Xiang JW. Breast cancer in Iraq, incidence trends from 2000-2009. Asian Pac J Cancer Prev. 2014;15(1):281-6.

Agarwal AA, Tambekar MY, Dhar R. Fine Needle Aspiration Cytology of Breast Carcinoma: A Comparative Study between Cytological and Histopathological Grading System with Lymph Node Status Assessment. 2016;3(10):27-35.

Shirish C, Gore CR, Aggarwal R, Vimal S, Deshpande AH. Robinson Cytological Grading of Breast Carcinoma on Fine Needle Aspiration Cytology-an Overview. Int J Pharm Biol Sci. 2013;3(2):2230-7605.

Ravikumar G, Rout P. Comparison of cytological versus histopathological grading of invasive ductal carcinoma of the breast with correlation of lymph node status. Middle East J Cancer. 2015;6(2):91–6.

Pradhan SP, Dash A, Choudhury S, Mishra DP. Robinson’S Cytological Grading on Aspirates of Breast Carcinoma: Correlation with Bloom- Richardson’S Histological Grading. J Evid Based Med Healthc. 2017;4(2):86-91.

Menu CJ. Comparative Study of Cytomorphological Robinson’s Grading for Breast Carcinoma with Modified Bloom - Richardson Histopathological Grading. 2013;2013:31-4.




How to Cite

Kareem, N. M., & Rahmatullah, N. S. (2018). Prognostic role of robinson cytological grading system in breast cancer in correlation with the histological grading of modified bloom richardson in Iraq. International Journal of Research in Medical Sciences, 6(4), 1139–1143.



Original Research Articles