Quality Control in Surgical Pathology
Achieving and maintaining desired level of histopathology and cytopathology test result is a challenging task. A well planned and executed Quality Control (QC) system is the core of good pathology practice, which spans from specimen collection to the time the clinician interprets a report. Systematic monitoring of QC ensures that all the compartments are functioning appropriately. It can detect, control, reduce and prevent errors through correcting deficiencies in a well planned and executed analytical process.
An accurate surgical pathology report which is issued timely and contains complete information is the basis of quality. Achieving quality requires standard basic infrastructure and inskilled manpower. Quality assurance and improvement works best when it is integrated into the system and carried out by well informed, well trained and knowledgeable staff.
Internal quality control
Quality assurance in pathology and laboratory medicine is the practice of assessing performance in all steps of the laboratory testing cycle including pre-analytic, analytic, and post-analytic phases. Five categories of monitors are used for measuring quality and improvement plans in surgical pathology. These should be built in to the system.
- Pre‐analytic include specimen fixation, delivery and identification, adequacy of clinical historyand preventing accessioning errors.
- Analytic part include peer review error rate, monitoring histology and gross room errors, slide quality, immunohistochemistry, frozen section-permanent section concordance and other ancillary study monitors.
- Post‐analytic quality monitors include errorsin transcription, verification report delivery, incomplete reports and correlation of diagnostic finding with ancillary studies (IHC, EM, FISH etc.).
- One important parameter of QC is the turn around time (TAT) for biopsy and frozen section reports which should be acceptable and low.
- Clinician satisfaction is directly related to the performance parameters described above and assessment of which is an important internal quality control parameter.
External quality control
World Health Organization (WHO) defines ‘External Quality Assessment’ (EQA) as a system for checking the laboratory’s performance, using an external agency or facility, proficiency testing (PT), rechecking or retesting by a reference laboratory and on site evaluation’. According to WHO guidelines for national EQA schemes, laboratories are encouraged to join EQA schemes that follow the WHO best practice guidelines.
Laboratory performance is checked and standardized using an external facility (EQA). Proficiency testing (PT) is method for achieving this through continuous learning, implementing new tests and maintaining quality for existing tests. PT is usually required for laboratory accreditation. College of American Pathologists (CAP) offers External Quality Assurance (EQA)/Proficiency Testing (PT) for all patient reportable tests.
To a large extent, histopathology reports are subjective. Descriptive nature of reports and non-uniformity of reporting patterns make implementation of quality control more difficult in histopathology.
Bangladesh perspective and some suggestions for improvement
Some components of internal quality assurance are followed in most of the laboratories. However, this is not done in organized way. Good quality supplies and well trained technologists are prerequisite for standardized slides for reporting. For pathologists, up to date knowledge and continued medical education are essential in this rapidly changing subject. Assessment of the current state, identification of lacunae/lapses and suggestion to improve are required. A national quality control board may be formed under BAP for external quality assurance. Big laboratories can enroll for EQA by CAP or other agencies and share their experience to smaller laboratories.
- R E Nakhleh. What is quality in surgical pathology? J Clin Pathol 2006;59:669–672. doi: 10.1136/jcp.2005.031385.
- Iyengar JN. Quality control in the histopathology laboratory: An overview with stress on the need for a structured national external quality assessment scheme. Indian J Pathol Microbiol 2009;52:1-5.
- WHO Manual for Organizing a National External Quality Assessment Programme for Health Laboratories and Other Testing Sites [Accessed 5 November 2017]
*Dr. Mohammed Kamal, Professor of Pathology, Bangabandhu Sheikh Mujib Medical, University, Shahbag, Dhaka 1000. firstname.lastname@example.org