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Impact of a national external quality assessment scheme for breast pathology in the UK
  1. I O Ellis1,
  2. D Coleman2,
  3. C Wells3,
  4. S Kodikara2,
  5. E M Paish1,
  6. S Moss2,
  7. S Al-sam4,
  8. N Anderson5,
  9. L Bobrow6,
  10. I Buley7,
  11. C E Connolly8,
  12. N S Dallimore9,
  13. S Hales10,
  14. A Hanby11,
  15. S Humphreys12,
  16. F Knox13,
  17. J Lowe14,
  18. J Macartney15,
  19. R Nash16,
  20. D Parham17,
  21. J Patnick18,
  22. S E Pinder6,
  23. C M Quinn19,
  24. A J Robertson20,
  25. J Shrimankar14,
  26. R A Walker21,
  27. R Winder22
  1. 1Department of Histopathology, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK
  2. 2Institute of Cancer Research, Cancer Screening Evaluation Unit, Sutton, Surrey SM2 5NG, UK
  3. 3Department of Histopathology, St Bartholomew’s Medical School, London EC1A 9DS, UK
  4. 4Department Histopathology, Broomfield Hospital, Chelmsford, Essex CM1 7ET, UK
  5. 5Department of Pathology, Royal Group of Hospitals Trust, Belfast BT12 6BA, Northern Ireland, UK
  6. 6Department of Histopathology, Addenbrooke’s Hospital, Cambridge CB2 2QQ, UK
  7. 7Department of Histopathology, The John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK
  8. 8Pathology Department, University College Hospital, Galway, Ireland
  9. 9Department of Histopathology, Llandough Hospital, Penarth, S Glamorgan CF64 2XX, Wales, UK
  10. 10Department of Pathology, Countess of Chester Hospital, Chester, Cheshire CH2 1UL, UK
  11. 11Department of Histopathology, St James’ University Hospital, Leeds LS9 7TF, UK
  12. 12Medical Solutions, Harley Street, London W1G 9QP, UK
  13. 13Department of Histopathology, Wythenshaw Hospital, Wythenshaw, Manchester M23 9LT, UK
  14. 14Department of Histopathology, University Hospital of North Tees, Hardwick, Stockton on Tees TS19 8PE, UK
  15. 15Department of Histopathology, University Hospitals Coventry and Warwickshire, Coventry, West Midlands CV1 4FH, UK
  16. 16Department of Cellular Pathology, St Georges Hospital, Tooting, London SW17 0QT, UK
  17. 17Department of Pathology, Royal Bournemouth Hospital, Bournemouth, Dorset BH7 7DW, UK
  18. 18NHS Cancer Screening Programmes, Sheffield ST10 3TH, UK
  19. 19Department of Histopathology, St Vincent’s University Hospital, Dublin 4, Ireland
  20. 20Department of Pathology, University of Dundee, Dundee, Tayside DD1 9SY, UK
  21. 21Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester Royal Infirmary, Leicester LE1 5WW, UK
  22. 22NHS Breast and Cervical Screening Programmes, Sheffield ST10 3TH, UK
  1. Correspondence to:
 Professor I O Ellis
 Department of Histopathology, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK; ian.ellis{at}


Background: This article presents the results and observed effects of the UK National Health Service Breast Screening Programme (NHSBSP) external quality assurance scheme in breast histopathology.

Aims/Methods: The major objectives were to monitor and improve the consistency of diagnoses made by pathologists and the quality of prognostic information in pathology reports. The scheme is based on a twice yearly circulation of 12 cases to over 600 registered participants. The level of agreement was generally measured using κ statistics.

Results: Four main situations were encountered with respect to diagnostic consistency, namely: (1) where consistency is naturally very high—this included diagnosing in situ and invasive carcinomas (and certain distinctive subtypes) and uncomplicated benign lesions; (2) where the level of consistency was low but could be improved by making guidelines more detailed and explicit—this included histological grading; (3) where consistency could be improved but only by changing the system of classification—this included classification of ductal carcinoma in situ; and (4) where no improvement in consistency could be achieved—this included diagnosing atypical hyperplasia and reporting vascular invasion. Size measurements were more consistent for invasive than in situ carcinomas. Even in cases where there is a high level of agreement on tumour size, a few widely outlying measurements were encountered, for which no explanation is readily forthcoming.

Conclusions: These results broadly confirm the robustness of the systems of breast disease diagnosis and classification adopted by the NHSBSP, and also identify areas where improvement or new approaches are required.

  • DCIS, ductal carcinoma in situ
  • EQA, external quality assessment
  • EWGBSP, European Commission working group on breast screening pathology
  • NHSBSP, National Health Service Breast Screening Programme
  • breast
  • external quality assurance
  • histopathology
  • pathology
  • quality assurance

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  • The authors of this manuscript are members of the EQA scheme management group of the UK national coordinating committee for breast pathology which is responsible for pathology quality assurance in the UK National Health Service Breast Screening Programme (NHSBSP) and preparation of minimum dataset standards in breast cancer pathology for the Royal College of Pathologists. The committee acts as the steering committee for the UK National Breast Screening Histopathology EQA scheme. The scheme is a member UK NEQAS.