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Participation in external quality assessment (EQA) aids laboratories in identifying systematic shortcomings. The aim of this study was to evaluate laboratories\u2019 improvement in IG\/TR analysis and interpretation during five EQA rounds between 2014 and 2018. Each year, participants received a total of five cases for IG and five cases for TR testing. Paper-based cases were included for analysis of the final molecular conclusion that should be interpreted based on the integration of the individual PCR results. Wet cases were distributed for analysis of their routine protocol as well as evaluation of the final molecular conclusion. In total, 94.9% (506\/533) of wet tests and 97.9% (829\/847) of paper tests were correctly analyzed for IG, and 96.8% (507\/524) wet tests and 93.2% (765\/821) paper tests were correctly analyzed for TR. Analysis scores significantly improved when laboratories participated to more EQA rounds (<jats:italic>p<\/jats:italic>=0.001). Overall performance was significantly lower (<jats:italic>p<\/jats:italic>=0.008) for non-EuroClonality laboratories (95% for IG and 93% for TR) compared to EuroClonality laboratories (99% for IG and 97% for TR). The difference was not related to the EQA scheme year, anatomic origin of the sample, or final clinical diagnosis. This evaluation showed that repeated EQA participation helps to reduce performance differences between laboratories (EuroClonality versus non-EuroClonality) and between sample types (paper versus wet). The difficulties in interpreting oligoclonal cases highlighted the need for continued education by meetings and EQA schemes.<\/jats:p>","DOI":"10.1007\/s00428-021-03046-0","type":"journal-article","created":{"date-parts":[[2021,3,8]],"date-time":"2021-03-08T21:02:41Z","timestamp":1615237361000},"page":"365-376","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Evaluation of a worldwide EQA scheme for complex clonality analysis of clinical lymphoproliferative cases demonstrates a learning effect"],"prefix":"10.1007","volume":"479","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4498-8386","authenticated-orcid":false,"given":"Cleo","family":"Keppens","sequence":"first","affiliation":[]},{"given":"Elke","family":"Boone","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3761-7050","authenticated-orcid":false,"given":"Paula","family":"Gameiro","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8464-9541","authenticated-orcid":false,"given":"V\u00e9ronique","family":"Tack","sequence":"additional","affiliation":[]},{"given":"Elisabeth","family":"Moreau","sequence":"additional","affiliation":[]},{"given":"Elizabeth","family":"Hodges","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7915-0946","authenticated-orcid":false,"given":"Paul","family":"Evans","sequence":"additional","affiliation":[]},{"given":"Monika","family":"Br\u00fcggemann","sequence":"additional","affiliation":[]},{"given":"Ian","family":"Carter","sequence":"additional","affiliation":[]},{"given":"Dido","family":"Lenze","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7335-3657","authenticated-orcid":false,"given":"Maria Eugenia","family":"Sarasquete","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1502-3032","authenticated-orcid":false,"given":"Markus","family":"M\u00f6bs","sequence":"additional","affiliation":[]},{"given":"Hongxiang","family":"Liu","sequence":"additional","affiliation":[]},{"given":"Elisabeth M. 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The ICMJE recommends that authorship be based on the following 4 criteria:\u25aa Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; and\u25aa Drafting the work or revising it critically for important intellectual content; and\u25aa Final approval of the version to be published; and\u25aa Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.All individuals listed as co-authors of the manuscript must qualify for every one of the four criteria listed above. Should an individual\u2019s contributions to the manuscript meet three of the criteria or fewer, then they should not be listed as a co-author on the manuscript; instead, their contributions should be acknowledged in the \u201cAcknowledgements\u201d section of the manuscript.The samples originated from leftover patient materials obtained during routine care. Each scheme organizer signed a subcontractor agreement stating that the way in which the samples were obtained conformed to the national legal requirements for the use of patient samples. The samples were excluded from research regulations requiring informed consent.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"EuroClonality is a scientific foundation that, together with the foundations EuroMRD and EuroFlow, is connected to the ESLHO foundation\/EHA scientific working group. The objectives of the EuroClonality Foundation are aimed at innovation, standardization, quality control, and education in the field of diagnostic clonality analysis. The revenues of the previously obtained patent (PCT\/NL2003\/000690), which is collectively owned by the EuroClonality Foundation and licensed to Invivoscribe, are exclusively used for EuroClonality activities, such as for covering costs of the Working Group meetings, collective WorkPackages (including the WorkPackage: External Quality Control, EQA), and the EuroClonality Educational Workshops.- Cleo Keppens has nothing to declare.- Elke Boone is a member of the EuroClonality Scientific Foundation and member of the WorkPackage EQA (assessor 2014\u2013now).- Paula Gameiro is a member of the Board of the EuroClonality Scientific Foundation, and chair of the WorkPackage EQA (assessor 2014\u2013now).- V\u00e9ronique Tack has nothing to declare.- Elisabeth Moreau is a member of the EuroClonality Scientific Foundation and member of the WorkPackage EQA (assessor 2015\u20132018).- Elizabeth Hodges is a member of the EuroClonality Scientific Foundation and member of the WorkPackage EQA (assessor 2014\u2013now).- Paul Evans is a member of the EuroClonality Scientific Foundation and member of the WorkPackage EQA (assessor 2017\u2013now), and has received honoraria and lecture fees from Novartis, Diceutics, and Astellas within the past 36 months, outside the scope of this research.- Monika Br\u00fcggemann is a member of the EuroClonality Scientific Foundation and member of the WorkPackage EQA (assessor 2014\u20132016), performed contract research for Affimed, Amgen, Regeneron, advisory board of Amgen, Incyte, and is a speaker for the bureau of Janssen, Pfizer, Roche.- Ian Carter is a member of the EuroClonality Scientific Foundation and member of the WorkPackage EQA (assessor 2017\u20132018).- Dido Lenze is a member of the EuroClonality Scientific Foundation and member of the WorkPackage EQA (assessor 2015\u20132017).- Maria Eugenia Sarasquete is a member of the EuroClonality Scientific Foundation and member of the WorkPackage EQA (2019\u2013now).- Markus M\u00f6bs is a member of the EuroClonality Scientific Foundation and member of the WorkPackage EQA (2019\u2013now).- Hongxiang Liu is a member of the EuroClonality Scientific Foundation and member of the WorkPackage EQA (assessor 2017\u2013now).- Elisabeth MC Dequeker has nothing to declare.- Patricia JTA Groenen is chair of the EuroClonality Scientific Foundation and member of the WorkPackage EQA (assessor 2014\u2013now).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}