The Practice of Cytopathology in India: Insights From a 2025 Nationwide Survey

Cytopathology is a widely practiced, low-cost diagnostic modality in India. However, nationwide data on infrastructure, contemporary practices, and use of ancillary techniques remain limited. We conducted a nationwide survey to describe current practice patterns and identify existing gaps. A cross-sectional online questionnaire (Google Form) was shared amongst practicing pathologists in India from June 12, 2025 to July 15, 2025. The data collected included laboratory type, specimen workload, staining, cell-block preparation, ancillary testing, adoption of standardized reporting systems, turnaround time (TAT), and use of digital pathology. Descriptive statistics were generated. Of 235 respondents, 84.7% (199/235) reported having a dedicated cytopathology laboratory; 130 (55.3%) were from teaching hospitals. FNAC remains widely practiced throughout the country: 72.8% of FNACs are performed by pathologists and 37% of centers receive > 2000 FNAC cases annually. Cell blocks were prepared in 72.3% (170/235) of centers; ancillary techniques were available in 37.9% (89/235). Standardized reporting systems were used by 80.9% (190/235) respondents, and 50.2% routinely performed ROSE. Only 10.2% had access to whole-slide imaging and 2.6% reported use of AI tools. A TAT of ≤ 24 h was followed in 46.8% (110/235) centers. Significant differences across center types were observed for reporting patterns, accreditation, ancillary testing, and quality assurance practices (p < 0.05). Cytopathology services in India are widespread but heterogeneous: infrastructure, ancillary testing, and digital adoption vary significantly with center type. Nation-wide efforts to standardize reporting, strengthen training in specimen triage, and expand accreditation and EQAS participation are essential to improve uniformity and quality of services.