Grading neoplasms is meant to associate morphology to increased death risk. This is the core of histopathology work and demands well-defined and reproducible histopathological criteria, together with stringent clinical observation.
The rule says the higher the grade the worse the prognosis. This is likely the simplest method to associate tumor biology as depicted by morphology – the face of cancer – to clinical behavior.
Particularly difficult is assigning risk to cancers with relatively bland histology but well-defined, slow-pace killer propensity. For such cancer subtypes, also named moderately aggressive, grading may require scoring multiple histology variables with demonstrated predictive value. Well-known examples are the scoring systems specific for prostate and breast adenocarcinoma [1,2].