The COVID-19 pandemic: implications for the cytology laboratory

Abstract

The coronavirus disease 2019 (COVID-19) is a pandemic caused by the SARS-CoV-2 virus. The infection has predominantly respiratory transmission and is transmitted through large droplets or aerosols, and less commonly by contact with infected surfaces or fomites. The alarming spread of the infection and the severe clinical disease that it may cause have led to the widespread institution of social distancing measures. Because of repeated exposure to potentially infectious patients and specimens, health care and laboratory personnel are particularly susceptible to contract COVID-19. This review paper provides an assessment of the current state of knowledge about the disease and its pathology, and the potential presence of the virus in cytology specimens. It also discusses the measures that cytology laboratories can take to function during the pandemic, and minimize the risk to their personnel, trainees, and pathologists. In addition, it explores potential means to continue to educate trainees during the COVID-19 pandemic.

Biosafety in the preparation and processing of cytology specimens with potential coronavirus (COVID‐19) infection: Perspectives from Taiwan

“…29,38,39 Other biocidal agents, such as benzalkonium chloride (0.05%-0.2%) and chlorhexidine digluconate (0.02%), are less effective. 39 Although both formalin and alcohol solutions with >70% alcohol are considered effective to inactivate SARS-CoV-2, it is unknown whether fixatives using alcohol solutions with lower concentrations, such as PreservCyt and CytoLyt (Hologic, 40 In addition, the WHO has recommended establishing a blame-free environment for workers to report incidents, encouraging self-assessment and symptom reporting, and arranging appropriate work hours with breaks. 36 Clinical specimens from suspected or confirmed COVID-19-positive patients should be transported as UN3373 Biological Substance Category B.…”

Interventional cytopathology in the COVID‐19 era

“…and with a high protection for the medical team. 15 We have extended the fixation times for DiffQuik stain to 60-90 s in order to maximize the time of exposition of the virus to alcohol. 17 Concerning the alcohol-fixed slides subsequently stained by Papanicolaou stain, we are using 95% alcohol solutions with fixation times prolonged to 30 min at least; although this method lowers the yield of the cytological sample, it allows to manage the smears safely.…”

“…Formalin and alcoholic solutions with alcohol concentrations above 70%-95% are considered effective to inactivate COVID-19. The effectiveness of other fixatives with lower alcohol concentrations, which are generally used in cytology laboratories, is not established 15. Since the outbreak of the COVID-19 pandemic, we have limited the number of liquid-based cytology (LBC) processed samples, because the fixatives required by this method contain low alcohol levels (Hologic Inc.) 15,16.…”

“…The effectiveness of other fixatives with lower alcohol concentrations, which are generally used in cytology laboratories, is not established 15. Since the outbreak of the COVID-19 pandemic, we have limited the number of liquid-based cytology (LBC) processed samples, because the fixatives required by this method contain low alcohol levels (Hologic Inc.) 15,16. However, if the use of LBC is necessary, a pre-fixation of the sample in a 70% alcohol solution is recommended according to the modified protocol described by Rossi et al,16 which fully meets technical and safety requirements.…”

International perspectives: Impact of the COVID‐19 pandemic on cytology

“…Cytology laboratories also are being impacted by this pandemic in several ways. 2 Specimens, especially respiratory samples, may be submitted for cytologic evaluation. Not only are these contagious samples to be handled with strict biosafety measures (eg, following biosafety guidelines from the Centers for Disease Control and Prevention), 3 but their cytologic findings may be unique and something we likely have not encountered before.…”