NHS Breast Pathology EQA

Team Leader: Dr Sue Moss

Location: Sir Richard Doll Building, Sutton

Section: Section of Epidemiology

NHS Breast Screening Pathology External Quality Assurance

The NHS Breast Screening Pathology External Quality Assurance (EQA) scheme was set up in 1990 to promote high quality histological reporting on biopsies resulting from breast cancer screening. The scheme organises a circulation of slides so that participants can carry out self-assessment using a standardised reporting proforma. Problems identified can be addressed through various initiatives, the success of which can be evaluated in further rounds of the scheme. Criteria for making diagnoses and reporting prognostic features have been developed and are defined in guidelines (first edition 1990, second edition 1995, third edition 2005).

Organisation

The EQA scheme is owned by the NHS Breast Screening Programme (NHSBSP).

The scheme is organised on a regional network basis mirroring the administrative network used by the NHSBSP. Each regional group has one, and in some of the larger regions two co-ordinators. The regional co-ordinators are members of the National Co-ordinating Committee for Breast Screening Pathology, which acts as the EQA Scheme Steering Committee. The Committee also has representatives from NHSBSP, CSEU, Wales, Scotland, Northern Ireland and Eire. The chairman of the National Co-ordinating Committee is responsible for organising the EQA Scheme.

The Secretariat is split between Nottingham University Hospitals NHS Trust and the Cancer Screening Evaluation Unit (CSEU) at The Institute of Cancer Research.

Operation

The NHSBSP has a published a General Description and Standard Operating Procedures of the scheme.

Two circulations of 15 cases (12 test and 3 educational cases) take place each year. The cases are selected and the type and mix of lesions included will vary from one circulation to the next. The Scheme Organiser obtains blocks containing pathology specimens from scheme participants through the regional network. All participants are eligible to submit cases and so please consider submitting a case to the Scheme Organiser when requested. Submitted material should arise from lesions, which have been screen-detected and should be sufficient to enable up to 70 sections to be cut from each block. The Scheme Organiser retains one slide from each block and the remaining slides are sent to the Regional Coordinators, along with a supply of printed reporting forms. These are subsequently circulated to pathologists within each region who are routinely involved in reporting on screening-derived breast pathology. Completed proformas are sent to CSEU for entry on to a database, and later analysis.

Two analyses for each circulation are performed; the timetable for inclusion in each of the analyses is determined by the Scheme Organiser and the CSEU. Participants are informed of the timetable by the Regional Coordinators. The first analysis is prepared in time for the meeting of the National Coordinating Group for Breast Screening Pathology; at a later date, a second analysis is performed, which includes proformas, which had not been received at the time of the first analysis. Results from the second analysis are sent to Regional Coordinators for distribution to participants in their region.

Participation

It is mandatory that consultant pathologists, who are routinely involved in reporting on breast pathology within the NHSBSP, participate in the scheme for which they are awarded CME points, 2 for completing a circulation and 1 for attending a regional meeting.  Participation is monitored and pathologists are expected to participate in at least two out of every three circulations.

At the end of each circulation, CSEU provides Regional Coordinators with the names of participants for that circulation. Participation in the scheme is not, therefore, anonymous. However, results for individual readers are confidential as these are presented using a code number rather than a name. Each participant is issued with a unique identification code by CSEU. The Scheme Organiser and Regional Coordinators do not have access to this information.

The EQA reporting form

The EQA reporting form is a modified version of the standard reporting form. The information that may be entered on the EQA form is restricted to data that can be supplied by examining histological sections alone. It is appreciated that participants may find the reporting form restrictive, but please bear in mind that additional information that does not comply with the format of the proforma cannot be analysed.

For further information, please visit our NHS Breast Screening Pathology EQA Frequently Asked Questions page.