Cytology in Taiwan
by: Howard H. Wu, M.D.
Taiwan is an island country, also known as Formosa, which means beautiful island. The population
in Taiwan is close to 23 million people living in an area approximately one- third the size of the
Indiana. With a total area of 36,179 sq. km, (13, 969 sq miles) Taiwan is separated from China by
the Taiwan Strait, which is about 220 km at its widest point and 130 km at its narrowest.
Pathologists and cytotechnologists in Kaohsiung Chung-Gung Memorial Hospital Pathology
Department listening to a lecture, “Transthoracic and transabdominal FNA cytology.”
The pathology practice is similar to Japan in the early years. However, there are many pathologists
going back to Taiwan after receiving training in the United States in the past 2 decades, and many
young pathologists have come to the United States for subspecialty study and research after
finishing their residency training in Taiwan in recent years. Now the system is very similar to the
United States.
There are two professional societies involving cytology training, education and certification, which
are Taiwan Society of Pathology and Taiwan Society of Clinical Cytology. Taiwan Society of
Pathology was established in 1967 and joined the International Academy of Pathology (IAP) in
2004, and became IAP Taiwan division.
The majority of the members are pathologists. The Taiwan Society of Pathology provides board
examinations to eligible pathologists once a year. By 2004, there were 300 members who were
board certified in anatomic pathology. Of them, 240 own a certificate with additional cytology
qualification. A new pathologist is required to attend a two week cytology workshop in order to get a
certificate with cytology qualification.
The second organization is the Taiwan Society of Clinical Cytology, which was established in 1988
and is a subdivision of the International Academy of Cytology (IAC). The members include
pathologists, cytotechnologists and non-pathologist clinicians such as endocrinologists,
gastroenterologists, and pulmonologists who provide cytology samplings and
interpretations. Because of the shortage of the pathologists and lack of expertise in cytology
among pathologists in Taiwan, many clinicians interpret the clinical cytology on their own. For
example, pulmonologists will read respiratory cytology, endocrinologists will interpret their own
thyroid fine-needle aspiration cytology, and gastroenterologists will do ultrasound guided liver FNA
and look at the FNA smears.
Effusion cytology, urine cytology and cervical Pap smears are routinely sent to pathologists for
interpretation. Cytotechnologists will screen these samples and then forward to pathologists for
final sign out. The cervical Pap smear screening and management for women follows the
guidelines of American Society for Colposcopy and Cervical Pathology and is sponsored by
Taiwanese government insurance.
There is no formal cytotechnology school in Taiwan. Most cytotechnologists have a B.S. or
associate degree in medical technology and then they have to go through one year clinical cytology
training in a teaching hospital in order to get a certificate. There are 365 cytotechnologist members
in the Taiwan Society of Clinical Cytology and many of them are also members of IAC. The work
done by cytotechnologists in Taiwan is basically similar to that of the United States.
I have had opportunities to go back to Taiwan to visit and to give a few cytology lectures every two
to three years over the past several years. There are more medical students choosing pathology as
their career and many hospitals send young pathologists to the United States for subspecialty
training. The practice in pathology and cytology in Taiwan is approaching that of the United States
and I am proud to play a small role in that process.
The author would like to thank Dr. Chiung-Ru Lai, Director of Cytology, Veteran General Hospital in
Taipei, for kindly providing the information.