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

Elena Vigliar¹, Rima Cepurnaite¹, Eduardo Alcaraz-Mateos², Syed Z Ali³, Zubair W Baloch⁴, Claudio Bellevicine¹, Massimo Bongiovanni⁵, Pavlina Botsun⁶, Dario Bruzzese¹, Lukas Bubendorf⁷, Reinhard Büttner⁸, Sule Canberk⁹, Arrigo Capitanio¹⁰, Chiara Casadio¹¹, Eugeniu Cazacu¹², Beatrix Cochand-Priollet¹³, Alessandro D'Amuri¹⁴, Catarina Eloy⁹, Marianne Engels⁸, Guido Fadda¹⁵, Gabriella Fontanini¹⁶, Franco Fulciniti¹⁷, Paul Hofman¹⁸, Antonino Iaccarino¹, Antonio Ieni¹⁵, Xiaoyin Sara Jiang¹⁹, Kennichi Kakudo²⁰, Izidor Kern²¹, Ivana Kholova²², Chinhua Liu²³, Anandi Lobo²⁴, Maria D Lozano²⁵, Umberto Malapelle¹, Zahra Maleki³, Pamela Michelow²⁶, Jamal Musayev²⁷, Gonca Özgün²⁸, Meltem Oznur²⁹, Francisca Maria Peiró Marqués³⁰, Pasquale Pisapia¹, David Poller³¹, Michal Pyzlak³², Betsy Robinson¹⁹, Esther Diana Rossi³³, Sinchita Roy-Chowdhuri²³, Mauro Saieg³⁴, Spasenija Savic Prince⁷, Fernando C Schmitt⁹, Francisco Javier Seguí Iváñez³⁰, Tajana Štoos-Veić³⁵, Oksana Sulaieva⁶, Brenda J Sweeney³⁶, Giovanni Tuccari¹⁵, Marie-Louise van Velthuysen³⁷, Paul A VanderLaan³⁸, Philippe Vielh³⁹, Patrizia Viola⁴⁰, Rinus Voorham⁴¹, Birgit Weynand⁴², Pio Zeppa⁴³, William C Faquin³⁶, Martha Bishop Pitman³⁶, Giancarlo Troncone¹

Affiliations

¹ Department of Public Health, University of Naples Federico II, Naples, Italy.
² Pathology Department, Jose M. Morales Meseguer University General Hospital, Murcia, Spain.
³ Division of Cytopathology, Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland.
⁴ Department of Pathology, University of Pennsylvania, Philadelphia, Pennsylvania.
⁵ Cytopathology, SYNLAB Suisse SA, Lausanne, Switzerland.
⁶ Laboratory of Pathology CSD, Kyiv, Ukraine.
⁷ Institute of Pathology, University Hospital Basel, Basel, Switzerland.
⁸ Department of Pathology, University Hospital Cologne, Cologne, Germany.
⁹ Medical Faculty, IPATIMUP, Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal.
¹⁰ Department of Pathology, Linkoping University Hospital, Linkoping, Sweden.
¹¹ Division of Pathology and Laboratory Medicine, European Institute of Oncology, Milan, Italy.
¹² Department of Morphopathology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Moldova.
¹³ Cochin Hospital, APHP University Medical Center of Paris, Paris, France.
¹⁴ Anatomic Pathology Unit, A. Perrino Hospital, ASL Brindisi, Brindisi, Italy.
¹⁵ Section of Pathological Anatomy, Department of Human Pathology "Gaetano Barresi", A.O.U. Polyclinic G. Martino, Messina, Italy.
¹⁶ Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.
¹⁷ Clinical Cytopathology Service, Histopathology Service, Cantonal Institute of Pathology, Locarno Cantonal Hospital, Locarno, Switzerland.
¹⁸ Laboratory of Clinical and Experimental Pathology, Hospital-related Biobank (BB-0033-00025), FHU OncoAge, Pasteur Hospital, Nice, France.
¹⁹ Department of Pathology, Duke University Medical Center, Durham, North Carolina.
²⁰ Department of Pathology, Izumi City General Hospital, Izumi, Japan.
²¹ University Clinic Golnik, Golnik, Slovenia.
²² Department of Pathology, Fimlab Laboratories, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
²³ Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
²⁴ Department of Pathology, Kapoor Path Laboratories, Raipur, India.
²⁵ Department of Pathology, University Clinic of Navarra, Pamplona, Spain.
²⁶ Department of Anatomical Pathology, University of the Witwatersrand, National Health Laboratory Service, Johannesburg, South Africa.
²⁷ Baku Pathology Center, Baku, Azerbaijan.
²⁸ Department of Pathology, Baskent University Faculty of Medicine, Ankara, Turkey.
²⁹ Department of Pathology, Tekirdag Namik Kemal University, Suleymanpaşa/Tekirdag, Turkey.
³⁰ Department of Pathology, General University Hospital of Alicante, Alicante, Spain.
³¹ Department of Pathology and Cytology, Queen Alexandra Hospital, Portsmouth, United Kingdom.
³² Center for Diagnostic Pathology, Warsaw, Poland.
³³ Division of Anatomic Pathology and Histology, Catholic University-University Polyclinic Foundation "A. Gemini," Rome, Italy.
³⁴ Department of Pathology, A.C. Camargo Cancer Center, Santa Casa Medical School, Sao Paulo, Brazil.
³⁵ Department of Pathology and Cytology, University Hospital Dubrava, Zagreb, Croatia.
³⁶ Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
³⁷ Department of Pathology, Erasmus Medical Centre, Rotterdam, The Netherlands.
³⁸ Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
³⁹ Medipath, American Hospital of Paris, Paris, France.
⁴⁰ North West London Pathology, Imperial College Healthcare, NHS Trust Charing Cross Hospital, London, United Kingdom.
⁴¹ Quirinus JM Voorham, PALGA Foundation, Houten, The Netherlands.
⁴² Department of Pathology, University Hospitals Leuven, Leuven, Belgium.
⁴³ Department of Medicine and Surgery, University of Salerno, Fisciano, Italy.

PMID: 33108683
DOI: 10.1002/cncy.22373

Free article

Meta-Analysis

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

Elena Vigliar et al. Cancer Cytopathol. 2020 Dec.

Free article

. 2020 Dec;128(12):885-894.

doi: 10.1002/cncy.22373. Epub 2020 Oct 27.

Authors

Affiliations

¹ Department of Public Health, University of Naples Federico II, Naples, Italy.
² Pathology Department, Jose M. Morales Meseguer University General Hospital, Murcia, Spain.
³ Division of Cytopathology, Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland.
⁴ Department of Pathology, University of Pennsylvania, Philadelphia, Pennsylvania.
⁵ Cytopathology, SYNLAB Suisse SA, Lausanne, Switzerland.
⁶ Laboratory of Pathology CSD, Kyiv, Ukraine.
⁷ Institute of Pathology, University Hospital Basel, Basel, Switzerland.
⁸ Department of Pathology, University Hospital Cologne, Cologne, Germany.
⁹ Medical Faculty, IPATIMUP, Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal.
¹⁰ Department of Pathology, Linkoping University Hospital, Linkoping, Sweden.
¹¹ Division of Pathology and Laboratory Medicine, European Institute of Oncology, Milan, Italy.
¹² Department of Morphopathology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Moldova.
¹³ Cochin Hospital, APHP University Medical Center of Paris, Paris, France.
¹⁴ Anatomic Pathology Unit, A. Perrino Hospital, ASL Brindisi, Brindisi, Italy.
¹⁵ Section of Pathological Anatomy, Department of Human Pathology "Gaetano Barresi", A.O.U. Polyclinic G. Martino, Messina, Italy.
¹⁶ Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.
¹⁷ Clinical Cytopathology Service, Histopathology Service, Cantonal Institute of Pathology, Locarno Cantonal Hospital, Locarno, Switzerland.
¹⁸ Laboratory of Clinical and Experimental Pathology, Hospital-related Biobank (BB-0033-00025), FHU OncoAge, Pasteur Hospital, Nice, France.
¹⁹ Department of Pathology, Duke University Medical Center, Durham, North Carolina.
²⁰ Department of Pathology, Izumi City General Hospital, Izumi, Japan.
²¹ University Clinic Golnik, Golnik, Slovenia.
²² Department of Pathology, Fimlab Laboratories, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
²³ Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
²⁴ Department of Pathology, Kapoor Path Laboratories, Raipur, India.
²⁵ Department of Pathology, University Clinic of Navarra, Pamplona, Spain.
²⁶ Department of Anatomical Pathology, University of the Witwatersrand, National Health Laboratory Service, Johannesburg, South Africa.
²⁷ Baku Pathology Center, Baku, Azerbaijan.
²⁸ Department of Pathology, Baskent University Faculty of Medicine, Ankara, Turkey.
²⁹ Department of Pathology, Tekirdag Namik Kemal University, Suleymanpaşa/Tekirdag, Turkey.
³⁰ Department of Pathology, General University Hospital of Alicante, Alicante, Spain.
³¹ Department of Pathology and Cytology, Queen Alexandra Hospital, Portsmouth, United Kingdom.
³² Center for Diagnostic Pathology, Warsaw, Poland.
³³ Division of Anatomic Pathology and Histology, Catholic University-University Polyclinic Foundation "A. Gemini," Rome, Italy.
³⁴ Department of Pathology, A.C. Camargo Cancer Center, Santa Casa Medical School, Sao Paulo, Brazil.
³⁵ Department of Pathology and Cytology, University Hospital Dubrava, Zagreb, Croatia.
³⁶ Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
³⁷ Department of Pathology, Erasmus Medical Centre, Rotterdam, The Netherlands.
³⁸ Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
³⁹ Medipath, American Hospital of Paris, Paris, France.
⁴⁰ North West London Pathology, Imperial College Healthcare, NHS Trust Charing Cross Hospital, London, United Kingdom.
⁴¹ Quirinus JM Voorham, PALGA Foundation, Houten, The Netherlands.
⁴² Department of Pathology, University Hospitals Leuven, Leuven, Belgium.
⁴³ Department of Medicine and Surgery, University of Salerno, Fisciano, Italy.

PMID: 33108683
DOI: 10.1002/cncy.22373

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.

Keywords: coronavirus disease 2019 (COVID-19); cytopathology; fine-needle aspiration; malignancy rate.

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Comment in

The state of cytopathology laboratories during the COVID-19 pandemic.
Faquin WC. Faquin WC. Cancer Cytopathol. 2020 Dec;128(12):881-882. doi: 10.1002/cncy.22393. Cancer Cytopathol. 2020. PMID: 33264514 Free PMC article.

References

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1. Royal College of Pathologists, Institute of Biomedical Science, the Association of Clinical Biochemistry and Laboratory Medicine, Association of Clinical Pathologists. Recommendations from RCPath and Professional Bodies (IBMS, ACP and ACB): Prioritisation/Deferral of Pathology Laboratory Work (in Light of SARS-CoV-2 (COVID19) Epidemic). Accessed September 21, 2020. https://www.rcpath.org/uploads/assets/f5123842-950f-49c5-bf69ed866a7ca3d...
1. College of American Pathologists. Cytopathology laboratory considerations during the COVID-19 pandemic: College of American Pathologists Cytopathology Committee. Accessed July 29, 2020. https://www.cap.org/laboratory-improvement/news-and-updates/cytopatholog...
1. COVID-19 - World Health Organization. Laboratory biosafety guidance related to coronavirus disease (COVID-19). https://www.who.int/

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

Affiliations

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

Authors

Affiliations

Abstract

Comment in

References

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Medical