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Providers of external quality assessment (EQA) programs evaluate data or information obtained and reported by participant laboratories using their routine procedures to examine properties or measurands in samples provided for this purpose. EQA samples must offer participants an equal chance to obtain accurate results, while being designed to provide results in clinically relevant ranges. It is the responsibility of the EQA provider to meet the necessary requirements for homogeneity, stability and some other properties of the EQA items in order to offer participants a fair, reliable and technically interesting EQA experience. Thus, the samples are at the heart and in the centre of EQA and its success depends on their quality. This manuscript describes the requirements for EQA samples and the activities of EQA providers to achieve them., (© 2024 Walter de Gruyter GmbH, Berlin/Boston.)

The European Organisation for External Quality Assurance Providers in Laboratory Medicine (EQALM) was founded in 1996 and currently has members from 29 European countries and 6 countries from outside Europe. EQALM provides a forum for co-operation and exchange of knowledge on quality-related matters in laboratory medicine, especially with regard to external quality assessment (EQA) programs in Europe. In addition, EQALM represent the EQA providers in laboratory medicine at European level vis-ŕ-vis political, professional, scientific and other bodies, including patients' organisations. To this end EQALM promotes activities such as organizing meetings with scientific and practical themes for members and other interested parties, issuing scientific publications, developing EQA projects and representing laboratory medicine EQA activities within other organisations and networks. EQALM is active in scientific and educational activity in different fields such as survey frequency, haematology, haemostasis, microbiology, nomenclature, virtual microscopy, traceability, accreditation, and quality assurance of the total testing process. The aim of this paper is to give an overview of the EQALM organisation., Competing Interests: None declared.

External assessment of analytical performance is part of the quality assurance in medical laboratory. These external controls are mandatory in Switzerland since 2006 for IgE analysis. The Swiss Society for Immunology and Allergy and the Swiss external quality centers had launched a program for total IgE, IgE specific for cat epithelium, birch pollen and peanut, and multi-specific IgE. They have set up criteria for proficiency assessment. Analysis of data obtained from 2006 to 2008 in the Quality Control Center Switzerland shows that results are very good for all the methods used and that a large number of participants fulfill the requirements to obtain the certificate of QUALAB conformity.

Objective: To assess whether Jass staging enhances prognostic prediction in Dukes' B colorectal carcinoma., Design: A historical cohort observational study., Setting: A university tertiary care centre, Switzerland., Subjects: 108 consecutive patients., Interventions: Curative resection of Dukes' B colorectal carcinoma between January 1985 and December 1988, Patients with familial adenomatous polyposis; hereditary non-polyposis colorectal cancer; Crohns' disease; ulcerative colitis and synchronous and recurrent tumours were excluded. A comparable group of 155 consecutive patients with Dukes' C carcinoma were included for reference purposes., Main Outcome Measures: Disease free and overall survival for Dukes' B and overall survival for Dukes' C tumours., Results: Dukes' B tumours in Jass group III or with an infiltrated margin had a significantly worse disease-free survival (p = 0.001 and 0.0001, respectively) and those with infiltrated margins had a significantly worse overall survival (p = 0.002). Overall survival among those with Dukes' B Jass III and Dukes' B with infiltrated margins was no better than overall survival among all patients with Dukes' C tumours., Conclusion: Jass staging and the nature of the margin of invasion allow patients undergoing curative surgery for Dukes' B colorectal carcinoma to be separated into prognostic groups. A group of patients with Dukes' B tumours whose prognosis is inseparable from those with Dukes' C tumours can be identified, the nature of the margin of invasion being used to classify a larger number of patients.

Objective: To compare specimen adequacy and detection of disease in conventional cytologic smears and CytoRich monolayer preparations., Study Design: Five hundred sixty pairs of conventional smears and monolayer preparations were compared. The conventional smear was made first, and the remaining cells were rinsed off into a vial containing transport medium. Monolayer slides were then prepared using the CytoRich system., Results: Evaluation of cases for specimen adequacy based on the Bethesda System demonstrated that the CytoRich method eliminated preparations of poor quality, reducing significantly the number of suboptimal specimens (28.3% for conventional vs. 8.4% for CytoRich). The final diagnosis concurred in 82.8% of cases. In 8 cases the CytoRich slide showed a low grade or more severe lesion, while the conventional smear was "atypical" (ASCUS) in 7 cases of squamous intraepithelial lesion and unsatisfactory in 1 case of invasive carcinoma. In three cases the conventional smear showed a low or high grade lesion, while the CytoRich slide was atypical., Conclusion: The CytoRich method significantly reduces suboptimal preparations and the associated ambiguous or inconsistent diagnoses. It detects cervical abnormalities better than does the conventional smear. It may result in cost savings for the community and benefit patients since unnecessary recalls are avoided.

A relatively low-cost computer-assisted image analysis system is described. Software has been specifically written for the continuous monitoring of absorbance readings on cryostat sections of plant tissues incubated in media to reveal enzyme activities. The equipment was tested by quantifying glucose-6-phosphate dehydrogenase activity in cryostat sections from shoot apices of spinach plants. The reaction rate of the dehydrogenase activity was monitored at two incubation temperatures, 20 degrees C and 30 degrees C. Control incubations were performed in media lacking substrate. The specific test minus control reaction at 30 degrees C was twice that at 20 degrees C. Variation of the substrate concentration at 30 degrees C yielded a Km value of 0.37 mM. These preliminary results show that our image analysis system can be used for kinetic measurements of dehydrogenase activity in frozen tissue sections and constitute a new approach for enzyme histochemistry in the shoot apical meristem.

In this prospective study, the independent prognostic value of DNA ploidy in combination with the major clinico-pathological characteristics (histological grade, nodal status, tumor size, estrogen and progesterone receptor status, number of tumors, multicentricity, lympho-vascular infiltration) was evaluated in a series of 399 breast-cancer patients. The mean follow-up time was 4.5 years. The DNA content was measured using image cytometry on fresh tumor samples. The overall survival of tetraploid and slowly proliferating diploid cases was significantly different compared with that of aneuploid and rapidly proliferating diploid cases (p = 0.0002). Thus, DNA ploidy combined with S-phase estimate (DNA histogram type) appeared to be good prognostic factors. In a multivariate survival analysis, DNA histogram type was not an independent prognostic factor unless the histological grade was excluded. This effect of DNA histogram type on survival was also observed among patients with grade-I or -II tumors and patients with small tumors. In conclusion, DNA histogram type was a valuable prognostic factor in univariate analysis, and provided independent complementary information for patients considered at low or intermediate risk by classical pathological findings.

In order to improve the technique of fine needle aspiration biopsy (FNAB), we developed a disposable syringe that allows one to perform aspiration with one hand while eliminating the need for a classic syringe holder. This study compared the cellularity and diagnostic adequacy of the material obtained with the new syringe and a syringe holder. Moreover, the acceptance of the new technique by physicians in training and by patients was tested. FNAB was performed with a syringe holder and the new syringe on 120 lesions from different body sites. The total number of diagnostic cells and their relative percentage were estimated. The results of the study indicated that the adequacy of a conclusive cytologic diagnosis was similar for both techniques. Moreover, a comparable cellular yield was demonstrated by a linear relationship between the total number of diagnostic cells (r = .84, slope = .83). The new technique was favorably accepted by physicians in training and patients. FNAB with the new syringe can be performed routinely.

DNA ploidy status of tumour cells is becoming a part of patient's record, because it brings an objective assessment of diagnostic and prognostic significance. DNA ploidy status in diagnosis--DNA ploidy status of some tumour types can be used as an adjunct to cytologic or histologic examination and provide an additional diagnostic information. For example, small cell lung carcinoma cells may be difficult to differentiate from cells of other benign neuroendocrine tumours. By computing the DNA malignancy grade, as defined by Bocking A. et al., it was possible to distinguish levels of malignancy among neuroendocrine tumours. Thus we were able to demonstrate that typical carcinoids may be differentiated from small cell carcinomas and atypical carcinoids. DNA ploidy status in prognosis--A large number of studies strongly support a correlation between DNA ploidy patterns and clinical course of malignant tumours. However, the prognostic value of DNA ploidy status has to be evaluated in relation to conventional clinico-pathologic characteristics, by multivariate analysis in order to demonstrate its independent contribution. For example, we demonstrated, in a prospective study of 211 colorectal adenocarcinomas, that ploidy status was an independent predictor of prognosis only in the early stages of the disease (Dukes' A, B, C), but not when advanced stages-(Dukes' D) were considered. In conclusion, DNA ploidy status may be used as an important objective parameter either in diagnosis or in prognosis, complementary to the traditional clinico-pathological characteristics.

A staining technique is presented in order to facilitate the automatic analysis of muscle biopsies. It renders possible the visualization on the same section of the myofibrillary adenosine-triphosphatase (ATPase) activity under the microscope with transmitted light, and of the fluorescent staining of fibronectin which marks the outlines of the muscle fibers by a simple switch to ultraviolet (UV) light.

The discovery of synchronous hepatic metastases from colorectal cancer poses a tactical problem ticklish to resolve. What are favourable circumstances for curative excision of hepatic metastases? When and how to operate them? To try to respond, we analysed a collective of 36 patients between 10. 1. 1985 and 30. 12. 1986. Of the patients staged Dukes B presenting synchronous hepatic metastases (less than 4, less than 50% of hepatic involvement by the tumour) without systemic involvement, excision at the first attempt is realizable and will be a benefit for the patient. For the others, excision is to be considered in the near future after having analysed (tumour grading and staging, CEA, ploidy of primary tumour). Patients presenting extrahepatic metastases will not benefit from hepatic resection. Surgery, associated or not to regional infusion chemotherapy is discussed.

A software package of general interest, and adapted to the analysis of histological sections has been written. The different programs of this package have been classified into four groups: macroanalysis, selection of fields, analysis, and data processing. The macroanalysis allows the acquisition of topographical information that will be used during the selection of fields and the analysis. Mapping programs have been added to the classical data processing of the measured parameters (statistical calculations, edition of values, histograms, graphs, .. .). They allow the generation of parametric images representing the distribution of particular elements in the section, or the topographical variations of calculated parameters. The recombination of information obtained at different magnifications, and the correlation of information of different types is thus possible and of great interest in the study of complex histological structures.

The analysis of ploidy provides valuable information allowing a more precise diagnosis, a more dependable prognostic and the choice of appropriate therapy. With ploidy analysis one can assess the aggressiveness of a given tumor. Aneuploidy of tumors clearly indicates a significantly lower patient survival index. Ploidy analysis of tissue sections yields a clear overall indication of the proportion of cells exhibiting hyperploidy within the tumor mass. The application of this approach is amenable to diverse types of tumors including colo-rectal neoplasias. Additionally, it provides a correlation with the histological presentation of each tumor. The study includes DNA ploidy analysis of 212 patients with primary adenocarcinoma. Sixty-four of the cases examined had follow-ups of a least 2 years. Eighteen of this group had diploid non-proliferating tumors, of which 2 (11%) subsequently died. Nineteen of the 64 had proliferating diploid tumors, 11 (58%) of whom died within the follow-up periods. Twenty-seven patients had tumors which were clearly aneuploid, 12 (45%) of whom later died. Our study demonstrates the prognostic value of ploidy analysis. The preliminary results indicate that mortality of patients with proliferating tumors is approximately 50% after 2 years. This prognostic is independent of other more classical criteria of tumor staging, namely Dukes' classification, histological differentiation and size of tumor. In the near future, ploidy analysis should be introduced as a standard part of tumor assessment. It clearly provides a valuable prognostic allowing the selection of patients requiring a careful follow-up.

This paper presents a new method for the quantitative analysis of the movement characteristics of spermatozoa. The method is based on (i) measuring the displacement of a spermatozoon observed using a microscope and (ii) automatically compensating for the displacement of the spermatozoon in order to keep it in the center of the microscopic field. The displacement of the spermatozoon is measured by on-line processing of digitized images of the microscopic field, acquired by an image analysis system. The motility characteristics of the same spermatozoon can be evaluated over prolonged periods of time (typically 10 min). The movement characteristics of 19 spermatozoa from five fertile donors were studied. At constant temperature, intradonor variations of the motility parameters were found. No statistically significant differences were found in the mean values of the motility characteristics for three of four donors. At increasing temperature, the mean curvilinear velocity, averaged on the 19 spermatozoa from the five donors, regularly increased between 23 and 30 degrees C and remained constant up to 38 degrees C.