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SUMMARY The inter-and intra-observer reproducibility of three grading systems for breast cancer has been analysed: those of the World Health Organisation, of Black, and of Hartveit. In addition, the components forming the basis of these grading systems were analysed separately with regard to reproducibility and interrelationship. In this analysis, degree of differentiation was also included as a parameter.The grading systems of WHO and of Black gave a stratification of the material into three categories of tumours, but that of Hartveit did not. All three systems had a low inter-and intra-observer reproducibility.Truncated component analysis indicated that the grading systems of WHO and of Black are closely related to each other and to the 'nuclear lobulation' component of Hartveit's system. The components 'pleomorphism', 'mitotic frequency', and 'hyperchromasia' of the WHO system were closely interrelated. Descriptors such as 'differentiation' and 'tubule formation' were interrelated but acted in a different direction from the others.It is surprising that few of the many suggestions for the classification and grading of breast carcinoma have been analysed with regard to intra-and interobserver reproducibility. This paper analyses the subjective grading of breast cancer suggested by the World Health Organisation (WHO) (Bloom and Richardson, 1957;Scarff and Torloni, 1968), Speer (1957), andHartveit (1971) in order to determine: (a) intra-and inter-observer reproducibility; and (b) interrelationships between the different parameters forming the basis of these grading systems.Any valid grading of breast cancer must use uniform diagnostic criteria which can be applied consistently by individual observers. Moreover, the grading should correlate with survival.Some authors who have analysed the significance of nuclear atypia have not confirmed that it is important in regard to the prognosis (Kister et al., 1969). Others have expressed scepticism concerning the value of prognosis based on histological features Received for publication 21 February 1978 Revised version received 22 March 1979 in connection with breast cancer (Evans, 1933;Warren et al., 1933;Richards, 1948;Lewison et al., 1953;Ackerman, 1954; Sternberg, 1958). Most grading systems have considered the nuclear morphology of the tumour cell population as important, but in some, other factors have also been evaluated such as histological structure, manner of growth, and extent of lymphocytic infiltration.The concept that the nuclear morphology of tumour cells could have implications ior their biological behaviour is due to von Hansemann (1893), and his studies have been the starting point for many grading systems of carcinoma. He considered the mitotic rate in the tumour and the occurrence of abnormal mitoses as important characteristics (Hansemann, 1892) and concluded (Hansemann, 1902) that the higher the degree of anaplasia, the greater the tendency of the tumour to metastasise. Broders (1940) introduced a grading system for squamous carcinoma of the lip a...

In eleven cases thirteen pancreatic islet cell adenomas were found in autopsy material from 1366 adult cases. Ten of the adenomas were solitary, while 3 small adenomas were observed in a single case. Another four possible solitary adenomas were observed, but their identity was uncertain owing to marked fibrosis. All the adenomas contained A-2 (A)-1 cells but no B (B)-1 cells. Nine of them also contained A-1 (D)-1 cells. The majority of cells in the adenomas were A-2 cells or cells which did not stain with any of the techniques used. The 4 possible adenomas contained islet cells (A-1, A-2, B) in different proportions. With one exception the patients with adenomas and possible adenomas were 65 years of age or older, and in some of these cases adenomas or hyperplasias were also found in other endocrine organs. The frequency of gastroduodenal ulcers or scars in the cases with adenoma or possible adenoma did not differ notably from that found in the cases without pancreatic adenomas. Among the cases with pancreatic adenoma and possible adenoma there were 3 patients with maturity onset diabetes mellitus, but otherwise no clinical symptoms of endocrine disturbances were noted.

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