q.c. histopathology

8/10/2019 Q.C. Histopathology

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QUALITY ASSURANCEIN

HISTOPATHOLOGY

QC should consider thewhole process :starting and finishing with thepatient.


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This covers the followings:

Patient benefit from biopsy.Patient consent.

Proper procedure & excision.


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Collection of adequate sample.

Collection of demographicaldata & clinical information.

Proper sample fixation.

Rapid transport to laboratory .


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On specimen receipt, record

patient identification .Macroscopic description &

sampling must be acceptable.Tissue processing must be

acceptable.Sections should be of goodquality


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Staining must be acceptable.

Pathologist should be qualified

Microscopic description is to beacceptable.

Stains & reagents are to beused properly


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Final diagnosis must be correct.

Biopsy must be properly assessed.

Report should contain patient

address & identification.Lab. is to store slides, blocks, &copy of the report .

Clinicians report copy must bedelivered rapidly.


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Correct report to correct patient.

Clinician must be able to read &understand the report.

Subsequent patient care is to becarried out properly.

Whole process must be rapid.

Clinician and lab. are to communicateto solve problems .


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Methods of Quality Assurance

1.Peer Review :

Laboratory compares its present

performance with its own pastperformance( self peer review).

Review covers strengths &weaknesses in histopathologyprocedures .


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2.Random Selection Audit

@ An audit picks randomly 2%of all cases from lab. records.

@ Audit checks each case for:*time taken for each stage of

the process,.*typing errors.


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proper description of specimen.

accuracy of diagnosis.

section quality,.

speed of pathologist's report .

accuracy of patient identification.

computer lab.processing & reporting


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3.Internal Quality Control

staff check section & stainquality before reporting

special stains needed should

be done

Proper controls are included


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4. External quality

assessment (EQA)Organizer sends to lab. samplesof fresh tissue.

Lab. is to fix & process samples

same as routine specimensExamined samples are sent to theorganizer .


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Organizer sends a report

that compares lab. resultswith those of participating

labs.

Sending fixed(not fresh)tissue cannot be identicalto all labs.


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Organizer prepares

sections for special stains& sends to participants.

Specific sections from

lab. archives are sent toorganizer for assessment .


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Organizer checks :

@ fixation , decalcification ,

processing, embedding ,microtomy ,

@ haematoxylin stain, eosinstain , artifacts, finishing


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Organizer report is in the

form of scores & explanationof why marks were lost.

Organizer offers educational

meetings & guidance to allparticipants.


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5. Benchmarking :

Falls into two groups :(1) Q-Track program:

@ similar to the random selectionaudit but in a small scale.

@ Q-Track covers all disciplines.

@ Comparison is made with other

labs of similar type.


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(2) Q-probe program:

@ It is a mutual discussionof selected topics in depth

@ It is run betweendifferent laboratories.


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@ Topics may include :

@ staging of breast carcinoma,.

@ physicians satisfaction with labservices,.

@ needle biopsies of prostate.

@ non - gyneacological cytology.


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6. QC of Histopathologists

Performance:

Five methodsare available :


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a)Total Review Audit : Histopathologist errors aredetected by reviewing report offinal diagnosis .

This is time-consuming.

Definition of clinical significanceremains that of a pathologist notthe clinician .


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b) Single Topic Audit :

A single topic is submitted

for audit .Common topics :

@ frozen section diagnoses,@ paraffin section report,

@ urine cytology service.


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c) Internal Q. ControlPoor results are due to:

@ defect in samples,

@ defect in techniques

@ incompetent pathologist


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Reports of large biopsies

must contain :

@ correct diagnosis.

@for tumors give : stage, grade,resection

Use checklists in reportingbiopsies.


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d) Diagnostic EQA:

@ Tests of diagnostic workare divided into :

1. tests of diligence, to check :

*errors of omission or oversight2. tests of competence, to check :

* experience, qualifications


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@ Organizer sends specimens to

participating pathologists.

@ Specimens are tested same as

routine samples .@ Diagnoses are returned to

organizer for analysis.@ Diagnosis is assessed, & areport is sent to pathologist.


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@Pathologist participate in :

a slide circulation schemethat allows him to compare his

report criteria with the group.

This is needed for cervicalcytology specimens .


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@ EQA is mainlyeducational leading to :

self-correction.

training of pathologists .


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@Poor EQA :does not mean unsafe

practice,

but it reflectsprofessional incompetence


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e) Statistical Analysis :Many samples are distributed

by organizer to different

pathologists .Organizer records :

@ range & frequency ofdiagnoses given by pathologist,@ rate of detection of

abnormalities by pathologist.


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Pathologist detecting:

@ abnormalities at ahigher or lower rate

* statistics are used to

assess significance of anydiscrepancy .


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f) Clinico-pathological

Meetings:benefit in :

Regular case discussions.

Audit & review of whole process :

@ from collection of biopsy torelease of report .


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Laboratory Accreditation

It is the external inspection

of quality in the lab.@ Organizations doing that are :

Clinical Pathology Accreditation

(UK)College of American Pathologists

(USA)


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@ Organization gives

lab.a list of therequired standards.

@ Lab. compares its

tests against thesestandards.


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@ Standards cover :

Laboratory organization &administration

Personnel : numbers, skills,qualifications.

Buildings, facilities, equipment.Quality & safety aspects.


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Policies,operating procedures

Staff: continuous education,conditions of work

Quality evaluation: audit &assessment procedures.

Relations of clinical staffwith hospital management.


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@ On compliance, organization

subjects lab. for inspection .

@ Inspectors check :

compliance with the standards

if clinicians are happy with lab.

service .hold meetings with the hospitalmanagement


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@ Organization feedbacklab.with :

areas of weakness & how to beremedied.

@ Re-inspection is repeatedat regular intervals.

q.c. histopathology

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