Cytologic grading of breast carcinoma

This letter is in reply to an article by Taniguchi E, Yang Q, Tang W, Nakamura Y, Shan L, Nakamura M, Sato M, Mori I, Sakurai T, Kakudo K (2000;44: 587-591). I was surprised to note there is absolutely no mention of the cytologic grading system for breast carcinoma that I devised in 1991 and that was published in the Lancet. A thorough literature search would surely have brought this article to light as well as some of the others referring to this grading system. It is especially surprising in view of the fact that some of the criteria that Taniguchi et al used in their grading system are identical to those that I described originally-namely, the three parameters for nuclear pleomorphism, nucleoli and chromatin pattern. I take issue particularly with a statement on page 589: "The features for cytologic grading of breast cancer have not been well established, and there have been only a few retrospective studies, with different conclusions." The grading system I described was tested prospectively, has been in use since 1991 and has stood the test of time, correlating well with the Bloom-Richardson histologic grading scheme. In fact, it is one of the cytologic grading systems mentioned in the guidelines published following the Bethesda Conference at the National Institutes of Health; they recommend cytologic grading of breast carcinomas