West Midlands Breast Screening Programme

External Quality Assurance (EQA)

External Quality Assessment Scheme for Breast Screening Histopathology: Overview

Introduction
The breast screening histopathology EQA scheme has three principal roles:

Educational
As a mechanism for examination of the concordance of pathology diagnosis within the UK
To provide a mechanism for individual performance appraisal

National Guidance
A pdf copy of NHSBSP publication 57, ‘External Quality Assessment Scheme for Breast Screening Histopathology is available here.

Organisation of the scheme
The scheme is organised on a regional basis. The regional co-ordinators are members of the National Co-ordinating Group for Breast Screening Pathology, which acts as the EQA scheme steering committee. The chairman of the National Co-ordinating Group is responsible for organising the EQA scheme.

Cases are selected at random within broad diagnostic categories. All participants are eligible to submit cases. Requests for submission are circulated through the regional network system, and participants are asked to identify a suitable case that they have reported in their practice in a period after a given date. Clinical details and the original diagnosis are not requested.

Administration of regional circulation of EQA cases is the responsibility of regional co-ordinators; for the West Midlands this is Dr David Rowlands. The task of circulating and monitoring the slide circulation is conducted by Miss Beckie Davies at the West Midlands Breast Screening QA Reference Centre.

Participants are classified as either breast screening readers or non-breast screening readers. The former group have contractual responsibility for provision of a breast screening pathology service within the UK NHSBSP. The latter group will have service commitments, which include provision of a breast pathology service outwith the NHSBSP.

Circulation
Two circulations per year, each consisting of 12 cases.

Definition of participation
It would be unreasonable to expect all participants to take part in each circulation, and participation is thus defined as taking part in two out of every three circulations.

Release of results
The general analyses of consistency of diagnosis and reporting prognostic features on individual cases are sent to all participants, who are thus able to see the spread of opinions on each case and how their opinions relate to those of the majority. There is evidence that this process improves diagnostic consistency. The secretary in the Cancer Screening Evaluation Unit links participants’ codes to their names and addresses so that the scheme organiser and other members of the Cancer Screening Evaluation Unit are unaware of individual participants’ opinions.

Further Information:
EQA Contacts