Between 2022 and 2025, the number of registered institutions in China’s pathology PT program experienced remarkable growth, with a compound annual growth rate of 86.6%. In 2025, a total of 657 institutions completed registration and participated in the assessment, covering eight major oncological pathology subspecialties—breast cancer, lung cancer, colorectal cancer, gastric cancer, thyroid, urothelial carcinoma, lymphoma, and cytopathology. This expansion reflects the rapid nationwide adoption of the PT program and strong recognition from the field.
However, the study revealed a notable structural issue. The distribution of participating institutions showed significant geographical imbalance, with institutions concentrated in economically developed provinces such as Guangdong, Sichuan, Shandong, Jiangsu, and Zhejiang, while participation from central and western regions, Northeast China, and Inner Mongolia remained markedly insufficient. At the institutional level, tertiary grade-A hospitals dominated the participant pool (64.8%), with public hospitals accounting for 92.2%. This pattern suggests that current high participation rates and strong performance largely reflect the capabilities of leading institutions rather than the full picture of national pathological diagnostic capacity.
County-level hospitals, as a critical force in primary healthcare, showed significantly lower participation breadth compared to non-county hospitals. The gap was especially pronounced in lymphoma—a field characterized by high diagnostic difficulty and stringent requirements for subspecialty expertise. Lymphoma pathological diagnosis relies heavily on specialized training and ancillary testing, and this disparity underscores the urgent need for capacity building at the primary care level.
Among all subspecialties, lymphoma achieved the highest PT scores, with a median approaching 95 points. Colorectal cancer and urothelial carcinoma scored approximately 85 points, while cytopathology recorded the lowest median score at approximately 68 points, highlighting the challenges of cytological diagnosis—possibly related to subjective interpretation and limited ancillary information. Notably, the high scores in lymphoma were closely associated with the highest proportion of tertiary grade-A hospital participants among all subspecialties—reinforcing the key finding that participant composition shapes performance outcomes.
This study is the first to systematically delineate the participation landscape of pathology PT at the national level. It clearly demonstrates that although China has established the capacity to conduct large-scale pathology quality assessment, structural imbalances across regions and institutional tiers mean that current overall performance may be overestimated. Future efforts should focus on developing targeted strategies to encourage active participation from underdeveloped regions and lower-tier healthcare institutions, thereby promoting balanced development of national pathological diagnostic capabilities.

DOI: 10.2738/PR.2026.0008