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.

Background In a previous worldwide survey, the authors showed a drastic reduction in the number of cytological specimens processed during the coronavirus disease 2019 “lockdown” period along with an increase in malignancy rates. To assess the continued impact of the pandemic on cytological practices around the world, they undertook a second follow‐up worldwide survey collecting data from the post‐lockdown period (2020). Methods Participants were asked to provide data regarding their cytopathology activity during the first 12 weeks of their respective national post‐lockdown period (2020), which ranged from April 4 to October 31. Differences between the post‐lockdown period and the corresponding 2019 period were evaluated, and the authors specifically focused on rates of malignant diagnoses. Results A total of 29 respondents from 17 countries worldwide joined the survey. Overall, a lower number of cytological specimens (n = 236,352) were processed in comparison with the same period in 2019 (n = 321,466) for a relative reduction of 26.5%. The overall malignancy rate showed a statistically significant increase (12,442 [5.26%] vs 12,882 [4.01%]; P < .001) during the same time period. Similar results were obtained if both malignancy and suspicious for malignancy rates were considered together (15,759 [6.58%] vs 16,011 [4.98%]; P < .001). Conclusions The data showed a persistent reduction in the cytological specimen volume during the post‐lockdown period (2020). However, the relative increase in the cytological workload in the late part of the post‐lockdown is a promising finding of a slow return to normality.

The Covid‐19 pandemic and ongoing war in Ukraine caused unprecedented disruption in healthcare, including cytopathology activities. This paper elucidates the effect of two consecutive disasters—the COVID‐19 pandemic followed by the war—on cytopathology practice in Ukraine through a single‐centre retrospective study. Total testing volumes, geographic distribution, and indicators of laboratory operations were assessed during three periods of 3 months each: the first 3 months of the acute phase of the war (March‐May 2022, period 1); summer (June‐August 2022, period 2); and the fall (September‐November 2022, period 3, associated with massive attacks on the energy infrastructure in Ukraine). These data were compared with the corresponding periods in 2020, during the COVID‐19 pandemic, and in 2021, the post‐lockdown period. The ongoing war in Ukraine has caused a dramatic disruption in routine health maintenance and cytological practice. A net decline in both PAP testing and non‐gynaecological pathology was associated with a geographic redistribution of cytopathological testing, and an increase in the rate of abnormal sample reporting. Despite these challenges, cytopathology practice in Ukraine demonstrates resilience, allowing for maintaining the healthcare system and addressing the needs of the civil population during the war. The ongoing war in Ukraine heavily affected cytological practice. The decline in PAP testing during the early period of the war was associated with an increase in the abnormal sample rate. Further study of the war's impact on the cervical pathology rate and the health of the population in the next decades is needed.

Aim: To investigate the impact of Russian invasion on Ukrainian healthcare services related to cytopathology screening and diagnostics.Methods: The workload and output of the cytopathological laboratory located in Kyiv before and during 8 months of Russian invasion were analyzed. The laboratory performance was assessed by the total number of cytologic cases, the turn-around time (TAT) index, and the percentage of timely reported test results. The geographic distribution of cases was also analyzed.Results: There was a significant decline in the workload of the laboratory during the first two months of the war, and the numbers of cytopathology specimens fell to less than one third of prewar levels, and the TAT was prolonged. Since May 2022, the efficiency and quality of cytopathologic testing has been largely restored in most parts of Ukraine, only to be affected again by increased Russian bombardment toward the end of summer 2022. The number of cytology specimens was reduced and the source of cytology specimens changed from the prewar conditions reflecting the relocation of the CSD Lab to western Ukraine.Conclusion: Cytolopathological screening and diagnostics were seriously disrupted in Ukraine during the Russian invasion resulting in a decreased volume of cytology specimens received in the CSD Lab during the early months of the war. By adapting to the war conditions and reorganizing the cytology services, CSD Lab has continued providing cytology services at a level of efficiency similar to those of the prewar period. However, the volume of cytology specimens remains much smaller than before war, indicating that the cytology services have been adversely affected by the war.