Xiang Tao1, R Marshall Austin2, Lingfei Kong3, Qing Sun4, Qinjie Lv5, Haimiao Xu6, Gang Meng7, Xianghua Huang8, Min Hao9, Qiao Zhou10, Xianrong Zhou11, Liantang Wang12, Yue Zhang13, Shuxia Xu14, Qingfang Shi15, Qi Zhou16, Linchuan Guo17, Sien Zeng18, Yulan Wang19, Jianhua Zhou20, Xiu Nie21, Lixiang Tian22, Danhua Shen23, Zi Lei24, Yixin Liu25, Jinhong Mei26, Kam Weng Wong27, Annie A Y Cheung28, Juan Li29, Minghua Zhu30, Chengquan Zhao31. 1. Department of Pathology, Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China. Electronic address: tutufoliage@hotmail.com. 2. Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 3. Department of Pathology, Henan Provincial Hospital, Zhengzhou, China. 4. Department of Pathology, Shandong Provincial Qianfoshan Hospital, Jinan, China. 5. Department of Pathology, Shengjing Hospital of China Medical University, Shenyang, China. 6. Department of Pathology, Zhejiang Cancer Hospital, Hangzhou, China. 7. Department of Pathology, Anhui Medical University, Hefei, China. 8. Department of Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, China. 9. Department of Obstetrics and Gynecology, The Second Hospital of ShanXi Medical University, Taiyuan, China. 10. Department of Pathology, West China Hospital, Sichuan University, Chengdu, China. 11. Department of Pathology, Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China. 12. Department of Pathology, The First Affiliated Hospital, Sun Yat-sun University, Guangzhou, China. 13. Department of Pathology, Horqin Right Front Banner People's Hospital, Ulanhot, China. 14. Department of Pathology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China. 15. Department of Pathology, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, China. 16. Department of Gynecological Oncology, Chongqing Cancer Hospital, Chongqing, China. 17. Department of Pathology, The First Affiliated Hospital of Soochow University, Suzhou, China. 18. Department of Pathology, Affiliated Hospital of Guilin Medical College, Guilin, China. 19. Department of Pathology, Xinjiang Military District General Hospital, Urumqi, China. 20. Department of Pathology, Xiangya Hospital, Central South University, Changsha, China. 21. Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. 22. Department of Pathology, Changchun Gynecological and Obstetric Hospital, Changchun, China. 23. Department of Pathology, Peking University People's Hospital, Beijing, China. 24. Department of Pathology, First Affiliated Hospital of Kunming Medical University, Kunming, China. 25. Department of Pathology, Tianjin Central Hospital of Gynecology Obstetrics, Tianjin, China. 26. Department of Pathology, The First Affiliated Hospital of Nanchang University, Nanchang, China. 27. Department of Obstetrics & Gynecology, Centro Hospitalar Conde de São Januário, Macau SAR, China. 28. Department of Pathology, HKU Cervical Cytology Laboratory and HKU-Shenzhen Hospital Cytology Laboratory, The University of Hong Kong, Hong Kong SAR, China. 29. Department of Pathology, Jinan Maternity and Child Care Hospital, Shandong, China. 30. Department of Pathology, Shanghai Changhai Hospital, Shanghai, China. 31. Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Electronic address: zhaoc@upmc.edu.
Abstract
INTRODUCTION: Cervical cancer rates in China remain high, with only limited opportunistic screening in urban centers and large mostly unscreened rural areas. Cervical cytology practices in China have been changing over the last decade with introduction of The Bethesda System reporting terminology, liquid-based cytology (LBC), and programs for cervical cytology screening of underserved rural populations. An effort was undertaken for the first time to collect nationwide data on cervical cytology laboratory practices in China, a possible first step toward increased standardization and potential development of nationwide cytology quality benchmarks. MATERIALS AND METHODS: Data on cervical cytology practices from 1572 laboratories operating in 26 nationwide Provisional Level Administrative Divisions was collected in an online survey approved through the Obstetrics and Gynecology Hospital of Fudan University in Shanghai. RESULTS: Over 90% of cervical cytology laboratories in China now solely use Bethesda System reporting terminology. LBC is now the most commonly utilized form of cervical cytology, with lower-cost Chinese-manufactured LBC formulations used in almost 70% of laboratories. Nationwide, significantly higher abnormal cytology rates were reported with LBC than with the conventional Papanicolaou smear (CPS); however, the CPS remains a useful low-cost alternative as China strives to extend cervical screening to large underserved rural areas. CONCLUSIONS: Abnormal cytology rates were not significantly different when different levels of hospitals were compared. The survey identified nationwide opportunities for cytology quality improvement, including low rates of reporting of unsatisfactory cases and low rates for atypical glandular cells.
INTRODUCTION: Cervical cancer rates in China remain high, with only limited opportunistic screening in urban centers and large mostly unscreened rural areas. Cervical cytology practices in China have been changing over the last decade with introduction of The Bethesda System reporting terminology, liquid-based cytology (LBC), and programs for cervical cytology screening of underserved rural populations. An effort was undertaken for the first time to collect nationwide data on cervical cytology laboratory practices in China, a possible first step toward increased standardization and potential development of nationwide cytology quality benchmarks. MATERIALS AND METHODS: Data on cervical cytology practices from 1572 laboratories operating in 26 nationwide Provisional Level Administrative Divisions was collected in an online survey approved through the Obstetrics and Gynecology Hospital of Fudan University in Shanghai. RESULTS: Over 90% of cervical cytology laboratories in China now solely use Bethesda System reporting terminology. LBC is now the most commonly utilized form of cervical cytology, with lower-cost Chinese-manufactured LBC formulations used in almost 70% of laboratories. Nationwide, significantly higher abnormal cytology rates were reported with LBC than with the conventional Papanicolaou smear (CPS); however, the CPS remains a useful low-cost alternative as China strives to extend cervical screening to large underserved rural areas. CONCLUSIONS: Abnormal cytology rates were not significantly different when different levels of hospitals were compared. The survey identified nationwide opportunities for cytology quality improvement, including low rates of reporting of unsatisfactory cases and low rates for atypical glandular cells.