Liver EQA Newsletter 22nd January 2013
Dear Liver EQA Member,
This newsletter is being sent by email and also hard copy with the results of the 2012 circulations F1 and G1, and includes information about the scheme for 2013.
1 Urgent call for cases
We have none left. There will be no circulation unless you send us cases – 20x H&E of suitable biopsies/ resections, plus one slide of necessary special stains. Submission form attached and on the website
Following discussion at the December meeting, special stains will be provided both as digital online images and as photographs with the circulated glass slides.
If your biopsies are too small to make spares – a topic of the December meeting was the use of 16g biopsy needles. These give significantly better specimens than the more commonly used 18g needles1, (about 1mm wide v. 0.7mm wide) with no increased risk (Royal College of Radiologists’ audit2,3). Dis.cuss this with your radiologists – 16g needles will be recommended in the second edition of the RCPath Tissue Pathways for medical liver biopsies.
2. Dates for 2013:
The BSG/ACP liver meeting will be in Coventry on 20th November2013, local host is Stefan Hubscher, GI meeting next day, 21st November. This is earlier than usual, so the autumn slide circulation will be earlier – dates below. Please contact Louise if this clashes with a holiday.
Circulation H1 – starts 15th April 2013, ends 22nd July 2013
Circulation I1 – starts 8th August, ends 1st November 2013
3. Results and certificates for F1 and G1
These are enclosed with the hard copy of this letter.All cases in G1 were suitable for scoring. In circulation F1, 4 cases achieved insufficient consensus to be included in scoring, but were of educational value (e.g. 392 – Wilson’s disease, 393 – alpha 1 antitrypsin deficiency, 394 – lymphoproliferative, not hepatitis C). These are highlighted in yellow on the scoring spreadsheet attached to the emailed version of this letter. For more details on scoring, please see the powerpoint presentations on the website, to which the scoring, comments and masterclass slides, have been added. If you want to review your responses, and see what the surveymonkey download of responses looks like, this will shortly available on the website. If you feel there has been a major mistake in the marking, please let me know! There will be a EQA members questionnaire coming soon this spring – please use this to comment on the way the scheme is run.
4. Educational participants
The opportunity to be an educational participant in the scheme was piloted in 2012. This presents the EQA cases as a self-assessment, using photomicrographs, digital slides or both, with the aim of using the educational value of the EQA scheme more widely.
Twenty-three pathologists took part in the pilots. All found this useful and would do it again (sometimes – 11, every time 12). It took 16/23 people ½-1 hour (3 less than 30 mins, 4 more than an hour).
The pilot scheme for F1 and G1 is still available via the liver CPD website. Participants get their score, a certificate, and a 4-5 page text summary of learning points from the cases. If you have colleagues or trainees who are interested, let them know about this. This is in a separate CPD section of the liver pages – although of course now the results of F1 and G1 are completed, educational participants could look these up if they didn’t want to use the ‘self assessment’ aspect of the exercise.
5. Liver fibrosis inter-observer variation study 2013
This was also discussed during the meeting on 6th December. The aim is to develop a simple way of describing the stage of chronic liver disease that (1) improves agreement on clinically relevant degrees of fibrosis, (2) can be applied to different aetiologies(3) is reproducible for specialists and non-specialists. We are looking for volunteers to test the reproducibility.
There were difficulties in assessing fibrosis using on-line digital images, but we want to avoid the logistical problems of slide circulation. The plan is therefore to take this forward using DVDs of digital images of fibrosis stains already available in Nottingham, thanks to Philip Kaye. At the meeting, many expressed interest in being part of this study. If you would like to know more please let Louise Osborne know, e.g. by replying to this email.
And a final reminder – please send us one or two EQA cases asap!
Best wishes,
Judy Wyatt
Organiser, National Liver Histopathology EQA Scheme
- RockeyDC, Caldwell SH, Goodman ZD, Nelson RC, Smith AD. Liver Biopsy – AASLD position paper. Hepatology 2009;49(3);1017-1044.
- Howlett DC, Drinkwater KJ, Lawrence D, Barter S, Nicholson T. Findings of the UK national audit evaluating image-guided or image-assisted liverbiopsy. Part I. Procedural aspects, diagnostic adequacy, and accuracy.Radiology. 2012 Dec;265(3):819-31.
- HowlettDC, Drinkwater KJ, Lawrence D, Barter S, Nicholson T. Findings of the UK National Audit Evaluating Image-guided or Image-assisted LiverBiopsy. Part II. Minor and Major Complications and Procedure-related Mortality.Radiology. 2013 Jan;266(1):226-35.