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    Impact of a national external quality assessment scheme for breast pathology in the uk

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    Date
    2006-02-01
    Author
    Ellis, I O
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    Cited 67 times in Scopus (view citations)
    
    Recommended Citation
    Ellis, I O (2006). Impact of a national external quality assessment scheme for breast pathology in the uk. Journal of Clinical Pathology 59 (2), 138-145
    Published Version
    http://europepmc.org/articles/pmc1860326?pdf=render
    Abstract
    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 k 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.
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    http://hdl.handle.net/10379/9127
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