Breast pathology guideline implementation in low‐ and middle‐income countries
Paolo Verderio, Sara Pizzamiglio, Angelo Paradiso · Cancer · 2009
We read with great interest the article concerning breast pathology guidelines implementation in low- and middle-income countries by Masood et al that was recently published in Cancer.1 The authors concluded that proper training in breast pathology for pathologists and laboratory technicians is critical and provides the underpinnings of program success for any country at any level of economic wealth. Educational activities and quality control (QC) programs have been recognized as part of the proficiency assessment for the determination of any biomarkers and have been demonstrated to be valid tools for improving reproducibility in biomarkers determination. However, the question of whether the improvement in reproducibility because of training is maintained as time goes on is still of great interest. Five years ago, we initiated a QC program for histologic grading on behalf of the Italian Network for Quality Assurance of Tumour Biomarkers (INQAT). Because the first round of this QC indicated a less-than-optimal level of reproducibility,2 a training course was planned; subsequently, 2 posteducational evaluations were implemented to verify both the short-term and long-term effects of the training on pathologist reproducibility.3 The reproducibility performance was assessed by means of the weighted kappa statistic (kw). Briefly, by comparing the interobserver reproducibility results concerning the short-term evaluation (median kw, 0.78) with those of the pre-educational study (median kw, 0.44), a noteworthy improvement was observed. However, the level of this improvement was found to decrease over time (median kw, 0.63). These results were further confirmed by considering the reproducibility between pathologists and the reference value. Our findings suggest the necessity to continuously monitor the quality of biomarker determination and the need to implement continuous training programs that are repeated sequentially in a “short-term interval” to improve, as much as possible, the performance level achieved. As pointed out by Masood et al,1 the use of telepathology could play an important role in implementing QC program as well as training sessions. Telepathology offers the advantage of permitting QC studies to be performed in a relatively short period of time, thereby allowing multiple identical samples to be distributed quickly without the limits of geographic distance, and to be archived and stored electronically.