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Review of the national external quality assessment (EQA) scheme for breast pathology in the UK
  1. Emad A Rakha1,
  2. Rachel L Bennett1,
  3. Derek Coleman1,
  4. Sarah E Pinder2,
  5. Ian O Ellis1
  6. On behalf of the UK National Coordinating Committee for Breast Pathology (EQA Scheme Steering Committee)
  1. 1Department of Histopathology, Nottingham City Hospital, Nottingham, UK
  2. 2Department of Research Oncology, King's College London, Guy's Hospital, London, UK
  1. Correspondence to Professor Ian O Ellis, and Professor Emad A Rakha, Division of Cancer and Stem Cells, Department of Histopathology, Nottingham City Hospital, University of Nottingham, Hucknall Rd, Nottinghamm NG5 1PB, UK; emadrakha{at}


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.

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  • Handling editor Cheok Soon Lee

  • Collaborators 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 data set 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 of UK NEQAS.

  • Contributors All authors contributed to the study.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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