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Review of the national external quality assessment (EQA) scheme for breast pathology in the UK

Rakha, Emad A.; Bennett, Rachel L.; Coleman, Derek; Pinder, Sarah E.; Ellis, Ian O.

Authors

EMAD RAKHA Emad.Rakha@nottingham.ac.uk
Professor of Breast Cancer Pathology

Rachel L. Bennett

Derek Coleman

Sarah E. Pinder



Abstract

Background: The National Health Service Breast Screening Programme (NHSBSP; pathology) external quality assurance (EQA) scheme aims to provide a mechanism for examination and monitoring of concordance of pathology reporting within the UK. This study aims to review the breast EQA scheme performance data collected over a 24-year period following its introduction.

Methods: Data on circulations, number of cases and diagnosis were collected. Detailed analyses with and without combinations of certain diagnostic entities, and over different time periods were performed.

Results: Overall, of 576 cases (172 benign, 11 atypical hyperplasia, 98 ductal carcinoma in situ/microinvasive and 295 invasive disease), consistency of assessment of diagnostic parameters was very high (overall k=0.80; k for benign diagnosis=0.79; k for invasive disease=0.91). For distinguishing benign versus malignant lesions, no further improvement is considered possible in view of the limitations of the scheme methodology. Although diagnostic consistency of atypical hyperplasia remains at a low level, combining it with the benign category results in a high level of agreement (k=0.93). The level of consistency of reporting prognostic information is variable and some items such as lymphovascular invasion and tumour size measurement may need further intervention to improve their reporting consistency. Although the level of consistency of reporting of histological grade remained at a moderate level overall (k=0.48), it was variable among cases and appears to have levelled off; no further significant improvement is expected and no significant impact of the previous publication of guidelines is observed.

Conclusions: These results provide further evidence to indicate the value of the breast EQA scheme in monitoring performance and the identification of specific areas where improvement or new approaches are required. For most parameters, the concordance of reporting reached a plateaux a few years after the introduction of the EQA scheme. It is important to maintain this high level and also to tackle specific low-performance areas innovatively.

Citation

Rakha, E. A., Bennett, R. L., Coleman, D., Pinder, S. E., & Ellis, I. O. (2017). Review of the national external quality assessment (EQA) scheme for breast pathology in the UK. Journal of Clinical Pathology, 70(1), 51-57. doi:10.1136/jclinpath-2016-203800

Journal Article Type Article
Acceptance Date Jun 9, 2016
Online Publication Date Jul 12, 2016
Publication Date Jan 1, 2017
Deposit Date Aug 9, 2019
Journal Journal of Clinical Pathology
Print ISSN 0021-9746
Electronic ISSN 1472-4146
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 70
Issue 1
Pages 51-57
DOI https://doi.org/10.1136/jclinpath-2016-203800
Public URL https://nottingham-repository.worktribe.com/output/2411382
Publisher URL https://jcp.bmj.com/content/70/1/51