China’s pathology proficiency programme expands but some regional gaps remain

A national assessment of enrolled 657 institutions across China in 2025, although participation remained concentrated in wealthier provinces and higher-tier hospitals

China’s pathology proficiency-testing programme has expanded rapidly – 657 institutions taking part in 2025 – but participation remains uneven across regions and hospital types, a recent study reported. The authors said this imbalance limits what the overall results reveal about diagnostic capacity across the country.

The programme assessed eight pathology areas: breast, lung, colorectal, gastric and thyroid cancers, urothelial carcinoma, lymphoma and cytopathology. From 2022 to 2025, the number of registered institutions grew at a reported compound annual rate of 86.6 per cent. Most participating institutions were in economically developed provinces, including Guangdong, Sichuan, Shandong, Jiangsu and Zhejiang. Central and western regions, north-eastern China and Inner Mongolia had fewer participants.

Tertiary grade-A hospitals made up 64.8 per cent of participants, while public hospitals accounted for 92.2 per cent. County-level hospitals took part less often than other hospitals, particularly in lymphoma assessment, which requires specialist expertise and supporting tests.

Median proficiency scores also differed by subspecialty. Lymphoma had the highest median, at almost 95 points. Colorectal cancer and urothelial carcinoma scored about 85 points, while cytopathology had the lowest median, at about 68. The authors noted that lymphoma’s high score coincided with a larger share of tertiary grade-A hospitals in that assessment, so participant mix may influence results.

The study provided the first national analysis of participation in the programme. Its findings showed that large-scale quality assessment is possible, but current scores may not represent all institutions equally. The authors recommended targeted measures to encourage participation by less-resourced regions and lower-tier hospitals.

The programme’s reach increased substantially between 2022 and 2025, but its geographic distribution did not reflect all parts of China equally. Participation remained particularly limited in central and western regions, north-eastern China and Inner Mongolia. County hospitals, which provide an important part of primary care, also took part less often than non-county institutions.

The difference was especially marked in lymphoma, where diagnosis often depends on specialist training and ancillary tests. Although lymphoma had the highest median assessment score, it also had the largest proportion of participants from tertiary grade-A hospitals. Cytopathology had the lowest median score, which the authors suggested might reflect the subjective nature of interpretation and limited ancillary information. These comparisons point to different training and support needs across pathology areas.

Because leading hospitals made up most of the participant pool, the results may overstate performance across the full national system. The authors recommend targeted support to improve participation and diagnostic capacity in lower-tier institutions and less-developed regions.

For further reading please visit: 10.2738/PR.2026.0008