Most commonly cited scheme is that of Fuhrman
- Requires simultaneous assessement of three features
  - Nuclear size may be subject to fixation variables and difficult to measure
  - No provision for cases with discrepant grade features
  - Poor interobserver agreement

	Nuclear Size	Nuclear Shape	Nucleoli
Grade 1	10 μ	Round, uniform	None
Grade 2	15 μ	Irregular membrane at 400X	Visible only at 400X
Grade 3	20 μ	Obvious membrane irregularities	Prominent, visible at 100X

Grade 4 carcinomas have bizarre, frequently multilobated nuclei with heavily clumped chromatin, may be sarcomatoid