Abstract
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. 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. 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%). 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.
Highlights
During the recent coronavirus disease (COVID-19) pandemic outbreak caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2),[1] several national health organizations and different pathology scientific societies recommended reductions in routine health maintenance due to the health emergency, which affected cytopathological practices around the world.[2,3,4,5] Normally, cytological specimens are obtained routinely regardless of whether the procedure is a screening procedure for more invasive histopathological examinations or a complete diagnostic, prognostic, and predictive evaluation
Participants were asked to report on the total number of processed cytological samples, the total number of exfoliative samples specifying the number of different specimen types, the total number of fine-needle aspiration (FNA) samples specifying the different sampling sites, and the distribution of diagnostic classes in nongynecological samples
The results of the current study demonstrated that the COVID-19 pandemic impacted cytology practices around the world by dramatically reducing the cytological specimen volume across specimen types by 45.3%
Summary
During the recent coronavirus disease (COVID-19) pandemic outbreak caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2),[1] several national health organizations and different pathology scientific societies recommended reductions in routine health maintenance due to the health emergency, which affected cytopathological practices around the world.[2,3,4,5] Normally, cytological specimens are obtained routinely regardless of whether the procedure is a screening procedure for more invasive histopathological examinations or a complete diagnostic, prognostic, and predictive evaluation. The only available data have been reported by single institutions, and demonstrate a decrease in cytological workload.[7,8] It is interesting to note that, despite the reduced activity, the rate of malignant diagnoses significantly increased.[8] single-institution reports are not robust enough to draw reliable conclusions on a global scale or for assessment of the effect of the prioritization of cytological samples from patients considered to be at high risk of malignancy. Because the implementation of a nationwide network and registry of cytopathology diagnoses still is limited, worldwide data are difficult to gather without a collective effort To fill this knowledge gap, a large number of cytopathologists from different countries reviewed their clinical reports to assess how cytological practices were impacted during the COVID-19 pandemic worldwide.
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