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Women in the UK should be reassured that the NHS breast screening programme (NHSBSP) is broadly performing satisfactorily, according to a national external scheme monitoring quality of diagnosis and reporting.
It found naturally high diagnostic consistency for in situ and invasive cancers and benign uncomplicated tumours but unacceptably low consistency in other instances. For histopathological grading, consistency could be improved if the NHSBSP guidelines are more specific and explicit, and for ductal carcinoma in situ if changes are made to the classification system. For atypical hyperplasia it will be less easy. Similarly, improving consistency for vascular invasion of tumours is a tricky prospect—but worthwhile because of prognostic importance.
These findings were based on analysis of the first ten years' data since 1990 on overall performance of pathologists and how the systems of diagnosis and classification in the breast screening programme are operating.
Performance was assessed by sending slides of stained sections from 12 breast cancer cases every six months to participating pathologists, who reported on them against the latest NHSBSP guidelines (1989, 1995) on a standard proforma modelled on the national reporting form. Reports were analysed by the national cancer screening evaluation unit for consistency. Evaluation started in 1990, when the external quality assessment (EQA) scheme was set up, initially with 220 pathologists, rising since to over 450.
The aims of the EQA are to increase consistency of diagnosis and also quality of prognostic information in reports, which can help to determine the best management for individual patients.
Ellis IO, et al.Journal of Clinical Pathology 2006;59:138–145.
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