Surgical Pathology and Oncology practices in India are very heterogeneous and driven by economic feasibility. With the widespread availability of targeted therapeutic options for various cancers, prognostic and therapeutic biomarkers have gained the forefront in guiding patient treatment and outcome. For maximum patient benefit, all test results should be reproducible. This requires a consensus form of testing and reporting across all the pathology laboratories. Quality should not be dependent on economics and with this vision in mind, we have started External Quality Assurance Scheme (EQAS) for surgical pathology under the realm of National Cancer Grid. Our Motto is “ONE PRACTICE FOR ALL”
The benefit of External Quality Assessment (EQA) is objective evaluation of a laboratory to detect variations in the quality, identify issues and guide them on corrective measures to achieve optimal and comparable results.
To ensure optimum quality in tissue processing, H&E diagnosis, and immunohistochemistry through Quality control schemes for proficiency testing.
NCG EQAS is a professional body independent of economical or political interests. We do our best to ensure transparency in our practices and methods. Pathology laboratories/hospitals are invited to participate in the schemes and enroll for the yearly programs by following the instructions on this webpage.
The NCG EQAS covers three aspects of histopathology viz:
Our focus has been always on tissue processing and immunohistochemistry and as these are process evaluation modules, they involve physical transport of EQA materials. The H&E diagnosis is conducted on a digital platform. The flow of our modules in brief is described below:
Through this module, we seek to improve diagnostic and predictive marker evaluation across the country. We assess the analytical process through this EQA and give suggestions to improve them. Pre-analytical processes are controlled by sending participants well fixed and processed specimens. A combination of different tumors spanning range of positive and negative diagnosis is encored on a tissue microarray (TMA) block. The unstained sections from tissue microarrays are then circulated to participants. The participant perform immunohistochemistry on the TMA section with their in-house protocols, interpret the TMA section staining and send the stained slides back. The NCG EQAS team then interprets the TMA for concordance, evaluates the enclosed IHC protocols and controls to give a final test concordance/ pass rate. A comprehensive report that includes participating performance for the given TMA, general performance of other peer laboratories and best practice protocols is then issued. This entire process from start to finish can vary from a fortnight to a month, depending on the rate of courier delivery back and forth.
For IHC, HER2 evaluation is the first run for the year, followed by ER and PR evaluated together a month later. We conduct one cycle(run) of Hematolymphoid panel and one or two runs of Miscellaneous panel, depending on the need, in the later part of the year.
The comprehensive list of standardized antibodies that is included in the EQA scheme is provided in the link below:
Click here to view
Quality of paraffin blocks decides success of all tests in histopathology. In the TSP module, we send across well fixed tissues from tumors to participants who process it using in-house protocols. The block and the H&E section from this block are sent to us which we then evaluate for quality. The run report includes assessment of participant’s own block and slide along with general performance of other laboratories and steps to improve on, if any. We conduct only one run of the TSP module annually, in the first quarter of the year.
In this program, participants/ pathologists are assessed for their diagnostic capabilities. There are two major modules of digital H&E diagnosis programs, within which we conduct two runs annually.
In specimens containing cancer, clinicians are looking for essential features on histopathology that help guide treatment. Pathologists have to be aware of various guidelines for reporting cancer to include these points in the report. In the MDSR module, we circulate a set of scanned slide images from a cancer resection specimen and ask participants to enter a complete report required for patient management. The images are made available for virtual viewing via a digital scanner. Participants are given access in batches (100 concurrent users) where they have to view the images, make an informed comprehensive opinion according to the guidelines for reporting and submit a report along with the final diagnosis for evaluation. The time frame between viewing and opining would vary on factors, like internet speed, level of system, experience of pathologist reporting, to name a few. Once the observations are compiled, the information is sent to the NCG EQAS team that then prepares an extensive report on the performance of the centers, critical elements in the histopathology report and why a pathologist should report it.
In this run, only diagnosis based on a single slide is evaluated. Each run would comprise a set of 3 different cases, consisting of one scanned slide per case, for virtual diagnosis. The results are then sent back to the NCG EQAS team for evaluation. A run report then follows on the performance of the participant along with general performance and discussion on the differential diagnosis.
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