JCP

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS REGISTER


[Advanced]
Journal of Clinical Pathology 2006;59:130-137; doi:10.1136/jcp.2004.025619
Copyright © 2006 by the BMJ Publishing Group Ltd & Association of Clinical Pathologists.
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this link to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Add article to my folders
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Parham, D M
Right arrow Articles by Patel, N
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Parham, D M
Right arrow Articles by Patel, N
Right arrowPubmed/NCBI databases
Medline Plus Health Information
*Breast Cancer

ORIGINAL ARTICLE

The NHS breast screening programme (pathology) EQA: experience in recent years relating to issues involved in individual performance appraisal

D M Parham1, D Coleman2, S Kodikara2, S Moss2, I O Ellis3, S Al-sam4, N Anderson5, L Bobrow6, I Buley7, C E Connolly8, N S Dallimore9, S Hales10, A Hanby11, S Humphreys12, F Knox13, J Lowe14, J Macartney15, R Nash16, J Patnick17, S E Pinder6, C M Quinn18, A J Robertson19, J Shrimankar14, R A Walker20, C Wells21, R Winder22, N Patel23

1 Department of Pathology, Royal Bournemouth Hospital, Bournemouth, Dorset BH7 7DW, UK
2 Institute of Cancer Research, Cancer Screening Evaluation Unit, Sutton, Surrey SM2 5NG, UK
3 Department of Histopathology, Nottingham City Hospital, Nottingham NG5 1PB, UK
4 Department Histopathology, Broomfield Hospital, Chelmsford, Essex CM1 7ET, UK
5 Department of Pathology, Royal Group of Hospitals Trust, Belfast BT12 6BA, Northern Ireland, UK
6 Department of Histopathology, Addenbrooke’s Hospital, Cambridge CB2 2QQ, UK
7 Department of Histopathology, The John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK
8 Pathology Department, University College Hospital, Galway, Ireland
9 Department of Histopathology, Llandough Hospital, Penarth, S Glamorgan CF64 2XX, Wales, UK
10 Department of Pathology, Countess of Chester Hospital, Chester, Cheshire CH2 1UL, UK
11 Department of Histopathology, St James’ University Hospital, Leeds LS9 7TF, UK
12 Medical Solutions, Harley Street, London W1G 9QP, UK
13 Department of Histopathology, Wythenshaw Hospital, Wythenshaw, Manchester M23 9LT, UK
14 Department of Histopathology, University Hospital of North Tees, Hardwick, Stockton on Tees TS19 8PE, UK
15 Department of Histopathology, University Hospitals Coventry and Warwickshire, Coventry, West Midlands CV1 4FH, UK
16 Department of Cellular Pathology, St Georges Hospital, Tooting, London SW17 0QT, UK
17 NHS Cancer Screening Programmes, Sheffield ST10 3TH, UK
18 Department of Histopathology, St Vincent’s University Hospital, Dublin 4, Ireland
19 Department of Pathology, University of Dundee, Dundee, Tayside DD1 9SY, UK
20 Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester Royal Infirmary, Leicester LE1 5WW, UK
21 Department of Histopathology, St Bartholomew’s Medical School, London EC1A 9DS, UK
22 NHS Breast and Cervical Screening Programmes, Sheffield ST10 3TH, UK
23 Department of Histopathology, Royal Sussex County Hospital, Brighton, East Sussex BN2 5BE, UK

Correspondence to:
Dr D M Parham
Department of Pathology, Royal Bournemouth Hospital, Castle Lane East, Bournemouth, Dorset BH7 7DW, UK; consultant.histopathologist{at}rbch.nhs.uk Background: The original role of the National Health Service breast screening programme (pathology) external quality assessment (EQA) scheme was educational; it aimed to raise standards, reinforce use of common terminology, and assess the consistency of pathology reporting of breast disease in the UK.

Aims/Methods: To examine the performance (scores) of pathologists participating in the scheme in recent years. The scheme has evolved to help identify poor performers, reliant upon setting an acceptable cutpoint. Therefore, the effects of different cutpoint strategies were evaluated and implications discussed.

Results/Conclusions: Pathologists who joined the scheme improved over time, particularly those who did less well initially. There was no obvious association between performance and the number of breast cancer cases reported each year. This is not unexpected because the EQA does not measure expertise, but was established to demonstrate a common level of performance (conformity to consensus) for routine cases, rather than the ability to diagnose unusual/difficult cases. A new method of establishing cutpoints using interquartile ranges is proposed. The findings also suggest that EQA can alter a pathologist’s practice: those who leave the scheme (for whatever reason) have, on average, marginally lower scores. Consequently, with the cutpoint methodology currently used (which is common to several EQA schemes) there is the potential for the cutpoint to drift upwards. In future, individuals previously deemed competent could subsequently be erroneously labelled as poor performers. Due consideration should be given to this issue with future development of schemes.

Abbreviations: EQA, external quality assessment; NHSBSP, National Health Service breast screening programme; RCPath, Royal College of Pathologists

Keywords: breast; cancer; pathology; screening; external quality assessment






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS REGISTER
Journal of Clinical Pathology Molecular Pathology
Terms and conditions relating to subscriptions purchased online  ¦  Website terms and conditions  ¦  Privacy policy
Copyright © 2006 by the BMJ Publishing Group Ltd & Association of Clinical Pathologists.