Geographic Distribution, Number, and Types of Papers Published in International Cytopathology Journals in the Last 5.5 Years: A Preliminary Study

The importance, value, and prevalence of cytopathology in daily practice have gradually increased with the introduction of novel technologies, especially in the detection and treatment of cancer [1‒3]. Concordantly, there has been an increase in the quantity and quality of cytology papers published by physicians and scientists. This is also positively reflected in the impact factor of cytology journals [4].

In this study, we investigated the geographic distribution of the papers published in international, Science Citation Index (SCI)-indexed cytopathology journals within the last 5.5 years. We aimed to show the number of publications per country of the institutions where these papers were produced.

This study analyzed the distribution per country of cytology papers published in five SCI-E and SCI-indexed international cytopathology journals with an impact factor higher than 1 within the past 5.5 years from January 2016 to June 2021. The analysis included Cancer Cytopathology, Cytopathology, Diagnostic Cytopathology, Acta Cytologica, and CytoJournal (online only). The papers were divided into two groups, “original papers” and “other contributions” (reviews, case presentations, brief reports, images in cytology, commentary, letters to the editor, and enigma portal). The papers’ geographic origin was assumed to be that of the author’s institution. In the case of multiple authors and countries, every country was added.

The total number of papers published in the 5 journals within the study period was 3,063, with 1,466 (47.8%) grouped as “original papers” and 1,597 (52.1%) grouped as “other.” The papers were submitted from 62 different countries (Table 1).

It was observed that the top 5 places in both the “original papers” and “other” categories were held by the USA (38.4%), India (16.8%), Japan (7.4%), Italy (5.5%), and Brazil (3.1%). A list of all 62 countries according to “original papers” and “other articles” published in the cytopathology journals included in our studies is shown in Table 2. The top 25 countries with original papers are presented in Table 3, while the top 25 countries with papers grouped as “other” are shown in Table 4. Distribution of the papers and types according to continent are presented in Table 5. Furthermore, the overall number and the relevant percentages of each category of papers are presented in a pie chart in Figure 1.

A general subgroup analysis was also performed on the original studies without a country breakdown. Cytomorphological, cytomorphological-immunohistochemical, and molecular assessments compose 38.5%, 45.7%, and 15% of the subgroups, respectively.

The papers classified as “others” varied according to the journals in which they were published. Each journal presented a different kind of study (such as a case report, image in cytology, correspondence, or review). Therefore, as described above, no statistical subgroup analysis was performed on the papers classified as “others.”

In this study, we analyzed the papers published in SCI-indexed international cytology journals by the number and type of paper and geographic distribution according to the country of origin. In parallel with advancements in science and technology, there has been development and change in the field of cytopathology in recent years [5‒7]. This has also enhanced interest in cytology journals and led to an increase in their impact factors [8].

We noted that papers from 62 countries across the world were included in the five cytology journals analyzed in our study. In recent years, developing countries have been showing progress in science and technology. Growth has also been observed in academic publishing in developing countries. Although the majority of scientific studies are still produced in developed countries, some studies show that the growth rate in these countries has stabilized and is lower than the growth rate in some developing countries [8‒10].

For instance, Brazil is the 5th country in terms of the number of papers, with a publication rate of 3.1% [11]. These studies reflect opinions on general academic publications. We do not have sufficient data to comment on cytopathology papers in this regard.

In our study, the USA produced 38.4% of all papers and is ranked at the top of the list. However, despite the widespread and sophisticated implementation of cytology in daily practice in Western European countries outside the UK (2.64% publication rate, ranked 7th), such as Germany, the Netherlands, and Scandinavian countries, they are ranked in the middle to lower end in terms of the cytology paper publication rate.

Meanwhile, a remarkable increase was observed in the number of cytology papers received from Southern European countries, such as Italy (ranked 4th; 5.5% publication rate) and Spain (ranked 6th; 2.6% publication rate), and Turkey (ranked 8th; 2.5% publication rate). This rate aligned with the study findings on general academic papers. A survey of the number of scientific publications listed in the Web of Science database shows that the growth rate in some Mediterranean countries, such as Spain, Italy, and Turkey, and Iran in the Middle East is faster than the world average [12].

The rate of growth in scientific production in the last 20 years was highest in Asia, led by India, Japan, China, and South Korea [10]. In our study, the overall geographic distribution was as follows: India was first, followed by the USA (16.8%), Japan in the 3rd place (7.4%), China in the 9th place (2.1%), and South Korea in the 10th place (1.6%). A comprehensive article published in 2003 reported that fine-needle aspiration cytology (FNAC) has been widely accepted and practiced all across India since the 1970s. The interest in cytology (especially FNAC) in India was also positively reflected in the number of publications. Of the 772 publications on FNAC from the developing world from 1987 to 2002, India alone contributed to 374 papers (48.4%) [13]. In our study, India is ranked 2nd among all countries in terms of cytopathology publications.

Except for a few examples, no paper was produced in most of the Balkan countries (Bulgaria, Serbia, Bosnia-Herzegovina, and North Macedonia), Malta, Slovakia, Belarus, Ukraine, and the Baltic countries (Lithuania, Latvia, and Estonia). Cytopathology has become a globally accepted diagnostic method due to its speed, accuracy, and cost-effectiveness [13‒15].

Increasing the diagnostic importance and value of cytology encourages the willingness and efforts of researchers in carrying out research and producing and publishing papers in this field. Putting their work into writing will help investigators clarify their investigative goals, contribute to the revision and interpretation of their data, and release their work for the benefit of the cytology community [16].

Cytopathology-related papers published on international platforms contribute to the dissemination of novel information and the implementation of cytology. A research project published in an accredited journal benefits both the investigator and his or her institution. The papers published in indexed journals also play a role in the appointment and academic upgrading of academicians. It should also be noted that cytopathology-related articles published in noncytopathology journals (e.g., Thyroid, Endocrine Pathology, etc.) were outside the scope of this study.

The rise in interest in cytology and its increased prevalence in medical practice have led to a broad geographic distribution of papers published in accredited cytology journals, as well as an increase in the number and quality of papers. For those devoted to cytology, it is highly satisfactory to see that the countries included in our study are located across a wide geographic spectrum and that there is an increase in the number of papers submitted by developing countries in addition to those coming from researchers in developed countries.

We have discussed our findings only based on our results in light of the literature. We acknowledge the shortcomings and limitations of our study. Our paper shows only the data acquired during the study period, and it should be regarded as a preliminary study on this particular topic.

In summary, we aimed to present a basic survey of the geographic distribution of manuscript submissions to high-impact cytopathology journals and use this analysis to point out emerging trends in cytology utilization and basic research. Our results offer an important insight into the changing landscape of cytology and suggest geographic regions that are ripe for the production of novel points of view and new research findings.

A part of this study was presented as a free paper at the 9th Turkish National Cytopathology Congress (virtual), March 26–28, 2021.

This study was exempt from institutional Ethics Committee approval as it was a retrospective study based on a web search. No human material or patient data was used. This study was performed upon the corresponding author’s initiative at his private cytopathology practice. However, permission was granted by the Provincial Health Department (October 12, 2021).

The authors declare no conflict of interest.

The authors disclosed that there is no funding relevant to this study.

Büşra Y. Bayrak collected the data and drafted the manuscript. Nadir Paksoy designed the study, analyzed the data, and provided guidance in writing the manuscript. Both authors read and approved the final manuscript.

Data are available from the authors upon request.