Table 5.

Comparison of Grading Systems for Mucoepidermoid Carcinoma

Modified Healey [22]	AFIP [21]	Brandwein [23]
Qualitative	Point based	Point based
Low grade	Intracystic component <20% = 2pts	Intracystic component <25% = 2pts
Macrocysts, microcysts, transition with excretory ducts	Neural invasion present = 2pts	Tumor invades in small nests and islands = 2pts
Differentiated Mucin producing Epidermoid Cells, often in a 1:1 ration; minimal to moderate intermediate cell population	Necrosis present = 3pts	Pronounced nuclear atypia = 2pts
Daughter cyst proliferation from large cysts
Minimal to absent pleomorphism, rare mitoses
Broad-front, often circumscribed invasion
Pools of extravasated mucin with stromal reaction
Intermediate grade	Mitosis (4 or more per 10 HPF) = 3pts	Lymphatic and/or vascular invasion = 3pts
No macrocysts, few microcysts, solid nests of cells	Anaplasia = 4pts	Bony invasion = 3pts
Large duct not conspicuous		>4mitoses per 10 HPF = 3pts
Slight to moderate pleomorphism, few mitoses, prominent nuclei and nucleoli
Invasive quality, usually well difined and uncircumscribed
Chronic inflammation at periphery, fibrosis separates nests of cells and groups of nests
High grade		Perineural spread = 3pts
No macrocysts, predominantly solid but may be nearly all glandular		Necrosis = 3pts
Cell constituents range from poorly differentiated to recognizable epidermoid and intermediate to ductal type adenocarcinoma
Considerable pleomorphism, easily found mitoses
Unquestionable soft tissue, perineural and intravascular invasion
Chronic inflammation less prominent, desmoplasia of stroma may outline invasive clusters
	Low grade = 0–4 pts	Low grade = 0 pts
	Intermediate grade = 5–6 pts	Intermediate grade = 2–3 pts
	High grade = 7–14 pts	High grade = 4 or more pts