Academic Pathology

Nottingham Breast Pathology Research Group


Breast cancer is the most common cancer and second leading cases of cancer related mortality. The Nottingham Breast Pathology Group's research is focused on refinement of breast cancer diagnosis, classification and outcome prediction using histological and molecular methods encompassing clinical and basic research.



Research issue

Our working hypothesis is that development of a modern clinically relevant classification system based on morphological and molecular genetic alterations will identify new targets for therapeutic development and improve patient management through improved prognostic information and therapeutic response prediction.

What we are doing about...

1. Breast disease classification

The Nottingham Breast Cancer Research Group and Nottingham Breast Pathology Research Group at Nottingham City Hospital have a longstanding research interest and international track record in classification of breast cancer, diagnosis of breast disease, evaluation of prognostic factors in breast cancer and understanding of the mechanisms governing hormone response and lymphovascular invasion in breast cancer.

We have developed a histological grading system, which has become the international gold standard for histological classification (WHO, UICC, EU and UK). The Nottingham Prognostic Index (NPI), also developed by the group, is regarded as the most effective system for clinical decision support in routine clinical management.

Ongoing research

We have active research programmes in each of the main molecular classes of breast cancer, Oestrogen receptor positive/luminal, Triple negative/basal-like and HER2 positive classes. These programs investigate molecular variation in terms of improving disease classification with respect to patient outcome and response to therapy.

We are developing an updated version of the Nottingham Prognostic Index-NPI+ which takes account of molecular sub classes as well as more focused use of prognostic factors and the Nottingham Px which utilises four routinely established markers combined into a cost-efficient index to classify the ER+, HER2-LN-group of breast cancer instead of the costly multigene assays.



2. Prognostic markers

Our group have examined a wide range of potential objective prognostic and predictive markers and have over the last 10 years been exploring the hypothesis that a novel classification of breast cancer based on phenotypic and molecular genetic characteristics will provide a more robust system for classification and therapeutic decision-making. The group have constructed one of the largest clinic-pathologically and molecularly characterised series of breast cancer in the world comprising 4000 invasive breast cancer and 1000 DCIS prepared as tissue microarrays.  Up to 400 biomarkers have been assessed using immunohistochemistry in addition to other techniques.


Current projects

  • Investigation of the molecular mechanisms underlying lymphovascular invasion in breast cancer
  • Molecular characterisation and outcome prediction of DCIS
  • Investigating Breast Cancer heterogeneity
  • NPI+: A new prognstic tool in breast cancer incorporating clinicopathological and molecular variables
  • Nottingham Px: A prognostic index aiming to stratify Luminal LN-negative breast cancer
  • Investigation of tumour infiltrating lymphocytes (TILs) as a prognostic and predictive marker in breast cancer
  • Investigation of the metabolic disturbance in breast cancer namely glutamine metabolism
  • Oestrogen receptor and HER2 expression in breast cancer: molecular interaction and clinical implications
  • Application of novel imaging technique; multimodal spectroscopy to diagnose breast cancer at excision margins and in lymph nodes intraoperatively
  • DNA damage response in breast cancer: moving from individual genes to pathways and networks

    The Nottingham Breast pathology Research group have an extensive network of collaborations in the UK and abroad. We have an average of 8 PhD students in addition to MSc and BMedSci students and visitors from the UK and elsewhere. 



World-leading breast cancer expertise

Professor Ian Ellis named among the world’s top 20 most influential experts on breast cancer

Professor Emad Rakha is a renowned breast pathologist in the UK and internationally


Our research is published in leading peer-reviewed journals with an average of 50 publications per year. Please see our members' profiles for publication details.

Educational Activities

The group run national training courses in breast pathology, the largest breast pathology second opinion service in the UK and the UK National Interpretive EQA scheme






Email Ian Ellis, Professor of Cancer Pathology

Email Emad Rakha, Professor of Breast Pathology and Consultant Pathologist














Academic Pathology

The University of Nottingham
School of Medicine, Queen's Medical Centre
Nottingham, NG7 2UH

telephone: +44 (0)115 969 1169