For detailed discussion of cases and responses, please see bottom of page.
From circulation 16 (Autumn 2009), images of slides can be viewed at: Leeds Virtual Pathology Webpage
National Head & Neck
General Description and terms of Membership
This general description outlines the procedures of the National Head and Neck Histopathology EQA Scheme (the Scheme). However, potential applicants are advised to consult the detailed Standard Operating Procedures (SOPs) (see link) before deciding to join the Scheme, as the SOPs also serve as the terms of membership, acceptance of which are a requirement for participation in the Scheme.
The Head & Neck Histopathology EQA Scheme is a United Kingdom-wide scheme set up by the British Society for Oral & Maxillofacial Pathology (BSOMP) with the aims of education, exchange of ideas, dispersal of new knowledge and ensuring high standards of performance in diagnostic histopathology. It is designed for specialists in both Oral & Maxillofacial and ENT histopathology and members are invited to select their field of expertise for personal performance analysis (see Acceptance of Terms of Acceptance form).
The SCHEME ORGANISING TEAM comprises:
Dr Adam Jones (Cardiff)
Dr Miranda Pring (Bristol)
Dr Tim Bates (Birmingham)
The SCHEME COORDINATOR is:
Availability and enrolment
Membership is available to those who report surgical pathology cases as independent practitioners working within the UK and Eire. Specialist Registrars and independent practitioners working outside the UK and Eire may access the circulated material for educational purposes and attend Review Sessions, but their responses are not scored and they do not have membership voting rights. Currently, around 160 UK practitioners are registered. Slide boxes are circulated to members who provide an NHS Trust address and will not be sent to home addresses.
The Organiser is happy to discuss any aspect of the Scheme and, on request, will provide additional information such as copies of the Schedules of Responses for previous circulations. New applicants should read the SOPs and complete an Acceptance of Terms of Membership form (see link), upon receipt of which you will be issued with your confidential participant code number.
If you wish to join, please visit the histopathology EQA website below:
Circulation of cases
There are two circulations of 18 slides per year, one in Spring and one in Autumn. Review Sessions are held in May (normally during the Annual Scientific Meeting of the BSOMP) and in either October or November.
Selection of cases (see SOP 4)
Cases for circulation are submitted by the membership. The 18 cases are divided into 6 “oral”, 6 “ENT” and 6 “common” and include intra-oral, pharyngeal and laryngeal biopsies, lesions from the salivary glands, jaws, nose and paranasal sinuses, ear, thyroid gland, neck and facial skin. Members are asked to select cases from their own department using the following guidelines:
• The cases must be a reflection of routine Oral & Maxillofacial and / or ENT histopathology practice. Extremely simple, bizarre and controversial cases should be avoided.
• A single H&E-stained section must be representative of the pathological process and permit diagnosis (or at least the formulation of a differential diagnosis).
• There must be sufficient tissue in the block to permit cutting of at least 50 sections.
Submission of Responses (see SOP 7)
New members are issued with a unique code number and should use this as the sole identifier on their Response Forms. Participants can make their diagnoses either by conventional glass slide, or by using the “virtual microscope” run by the University of Leeds (see link). Submissions of responses is online via the relevant Circulation tab once you have logged on to the dedicated H&N EQA website http://www.histopathologyeqa.org/. A deadline for submission of responses is issued with each circulation, which participants are expected to meet. Late responses are assessed at the discretion of the Scheme Organiser.
Analysis and Scoring of Responses (see SOPs 7 and 8)
After the closing date, the Organiser analyses the returns for each case and prepares a summary schedule showing the range and frequency of the submitted diagnoses. This Schedule of Responses is distributed at the Review Session and forms the basis of the discussion and mark allocation. At least 25% of the respondents to the circulation under discussion must be present for the Review Session to be quorate.
Marks are given to individual responses as follows:
• Two marks are given to responses that are judged accurate, complete and correct
• One mark is given to responses that are judged incomplete or deficient, but not necessarily incorrect
• No marks are given to answers that are judged to be wrong
The following example illustrates a possible likely marking scenario:
Adenomatoid odontogenic tumour 2 marks (correct)
Benign odontogenic tumour 1 mark (incomplete)
Dentigerous cyst 0 marks (wrong)
Feedback to Members (see SOP 9)
After the Review Session, the Organiser marks the Response Forms according to the scoring system agreed at the Review Session. The marks are entered into a table that shows the chosen specialist arm or arms, the score awarded for each individual case, and the total score, for each member represented by their unique code number. The table is circulated to all members within six weeks of the Review Session together with the Minutes of the Review Session.
CPD (see SOP 9)
Participation in a circulation and attendance at the Review Session earns four CPD credits if 12 responses were submitted, five if 18 responses were submitted. Participation in a circulation and receipt of feedback earns two credits if 12 responses were submitted, three if 18 responses were submitted. Members who attend a Review Session but did not submit their responses earn two credits. Certificates for CPD portfolios will be issued by the Coordinator and circulated with the notes of the Review Session.
Persistent Substandard Performance (see SOP 10)
Essentially, two or more 0 scores in 12 responses, or three or more 0 scores in 18 responses, will normally automatically be flagged as a substandard performance. Substandard performance “triggers” Action Points. The First Action Point is triggered when a participant’s performance is substandard in two out of three successive circulations. A similar performance in two out of the next three circulations, or a failure to participate (without documentary evidence of a valid reason) in any of the next three circulations, will trigger the Second Action Point.
Participation (see SOP 11)
The minimum acceptable level of participation is two out of three consecutive circulations calculated on a rolling basis provided the First Action Point has not been reached. Documentary evidence should be provided for non-participation for reasons of illness, sabbatical or maternity leave. Non-participation due to a heavy workload is not an acceptable reason.
Financial Aspects, Oversight and Complaints
The Scheme is sponsored by the BSOMP. It is overseen by the National Quality Assurance Advisory Panel for Histopathology & Cytopathology and the Steering Committee for Interpretative EQA of the Royal College of Pathologists.
Reviews & Discussion of EQA cases