Global impact of the COVID‐19 pandemic on cytopathology practice: Results from an international survey of laboratories in 23 countries

Abstract

BACKGROUND: To the authors' knowledge, the impact of the coronavirus disease 2019 (COVID-19) pandemic on cytopathology practices worldwide has not been investigated formally. In the current study, data from 41 respondents from 23 countries were reported. METHODS: Data regarding the activity of each cytopathology laboratory during 4 weeks of COVID-19 lockdown were collected and compared with those obtained during the corresponding period in 2019. The overall number and percentage of exfoliative and fine-needle aspiration cytology samples from each anatomic site were recorded. Differences in the malignancy and suspicious rates between the 2 periods were analyzed using a meta-analytical approach. RESULTS: Overall, the sample volume was lower compared with 2019 (104,319 samples vs 190,225 samples), with an average volume reduction of 45.3% (range, 0.1%-98.0%). The percentage of samples from the cervicovaginal tract, thyroid, and anorectal region was significantly reduced (P < .05). Conversely, the percentage of samples from the urinary tract, serous cavities, breast, lymph nodes, respiratory tract, salivary glands, central nervous system, gastrointestinal tract, pancreas, liver, and biliary tract increased (P < .05). An overall increase of 5.56% (95% CI, 3.77%-7.35%) in the malignancy rate in nongynecological samples during the COVID-19 pandemic was observed. When the suspicious category was included, the overall increase was 6.95% (95% CI, 4.63%-9.27%). CONCLUSIONS: The COVID-19 pandemic resulted in a drastic reduction in the total number of cytology specimens regardless of anatomic site or specimen type. The rate of malignancy increased, reflecting the prioritization of patients with cancer who were considered to be at high risk. Prospective monitoring of the effect of delays in access to health services during the lockdown period is warranted. Cancer Cytopathol 2020;0:2-10.

The state of cytopathology laboratories during the COVID‐19 pandemic

“…In addition, the study by Wang et al described modifications to the structures of the laboratory workforce, and changes in cytopathology specimen volumes and laboratory workflows. Similar to the study by Vigliar et al, 3 Wang et al 4 also observed a reduction in cytology specimen volumes, although to a lesser degree than in the study by Vigliar et al It remains to be seen how the COVID‐19 pandemic will affect various aspects of cytopathology laboratories as we move into 2021 among fears of a second surge in infections, but hopes are high for the development and distribution of an effective vaccine to bring some stability to the situation. In the interim, laboratories worldwide are publishing and sharing their experiences and, through a global effort, appear poised to meet the challenges that lie ahead.…”

“…This month's issue of Cancer Cytopathology includes several original articles, commentaries, and correspondence describing a wide range of topics related to the effects of the COVID‐19 pandemic on the field of cytopathology. In particular, the journal features 2 large, multi‐institution studies investigating the effects of the COVID‐19 pandemic on the function of cytopathology laboratories around the world 3,4 . Vigliar et al have presented their study describing an astounding 45.3% decrease in the number of cytology specimens during the peak of the pandemic compared with before the pandemic 3 .…”

“…In particular, the journal features 2 large, multi‐institution studies investigating the effects of the COVID‐19 pandemic on the function of cytopathology laboratories around the world 3,4 . Vigliar et al have presented their study describing an astounding 45.3% decrease in the number of cytology specimens during the peak of the pandemic compared with before the pandemic 3 . Just as overall cytology caseloads were decreasing, the authors observed a modest increase in the rate of nongynecologic samples classified as “malignant,” presumably reflecting a shift in cytology samples toward those from patients who were considered to have more life‐threatening disease, especially critical cases of cancer.…”

Cytopathology practice during the COVID‐19 postlockdown: An Italian experience

“…Unfortunately, since the beginning of the current health crisis, restrictive measures, imposed to thwart the relentless spread of COVID-19, have dramatically disrupted many health care services, not least cytopathology practices. 1,2 Although the Italian government eased safety measures on May 4, 2020, the impact of the coronavirus emergency persisted beyond the end of the lockdown. Indeed, our clinic experienced an overall workload reduction of 41.6% in the first weeks of the postlockdown.…”

Senology at the time of the coronavirus – What we did or should learn from the COVID-19 pandemic

“…In many breast cancer disease settings, significant decreases and delays in iden-tifying new cancers and deliver standard of care have been reported [5,6], which increased patients' worries and discomfort [7]. All steps of the breast cancer treatment pathway have been impacted, from radiologic [8], histopathologic [9] diagnosis and genetic testing [10], to loco-regional and systemic therapies [11][12][13]. Despite some general data suggest patients receiving cancer-directed therapy may have prolonged detectable coronavirus [14] and experience higher prevalence of both infection and hospitalization rates and worse outcomes [15,16], the little available evidence specific to breast cancer patients does not show differences in disease severity and outcomes compared to non-oncological COVID-19 patients [17].…”