Quantifying the hidden impact of COVID‐19 pandemic: The cytology perspective

Abstract

Background The burden of the COVID‐19 pandemic is often enumerated in lives lost, but the strain on health care resources and mobility limitations contributed to the burden of non–COVID related disease. In this study, we evaluated the impact of the pandemic through a time series review of cytology samples. Methods Pathology reports for all cytology specimens received from January 2019 through April 2021 at our institution were reviewed. Time series analysis was performed using moving averages, time trend analysis, cross‐correlation, and tests of homogeneity. Results During the first peak of the pandemic (March–June 2020), breakpoint analysis showed a downward shift in the number of gynecologic (−89.4%) and non‐gynecologic (−70.4%) cytology specimens within a week of declaration of an emergency. Cross‐correlation analysis showed a relationship between sample numbers and COVID‐19 cases during the initial phase of the pandemic (April–June 2020). During the second surge (October 2020–April 2021), despite the higher incidence of COVID‐19, there was a smaller impact on cytology samples (−20.1% and − 24.8% for gynecologic and non‐gynecologic samples, respectively). During the first 3 months of the pandemic, 154 fewer malignant cases were identified compared with the prior year. Although specimen numbers slowly returned to baseline following the first wave of the pandemic, the earlier decline in malignant diagnoses was not offset during the study period. Conclusions The deleterious effects of COVID‐19 extend beyond direct mortality attributed to the disease. The significant decrease in diagnostic cytology specimens during this period has profound implications including delayed care and missed disease.

Thyroid FNA cytology: Impact of the COVID‐19 pandemic and vaccination in a Brazilian series

“…4 In addition, an absolute deficit of malignant cases of gynecologic and nongynecologic specimens identified in a different study during the first 3 months of the pandemic, compared with the previous year, raised concern that, regardless of the changes in specimen numbers, the relative increase in the malignancy rate may be less meaningful than changes in the absolute numbers of malignant diagnoses not rendered. 15 Different from other sites, only a small proportion of thyroid nodules are diagnosed as suspicious for malignancy or malignant, 28,29 with the most common thyroid malignancy being low-risk papillary carcinoma. Although some patients experienced disease progression during COVID-19 delays in the receipt of endocrine disease-related care, most patients with followup did not.…”

“…For some specimen types, the malignancy rate was persistently higher, 14 reflecting the prioritization of patients with a higher risk for cancer. Regardless of the changes in specimen numbers and the relative increase in the malignancy rates, one study reported an absolute deficit of malignancy cytology cases during the initial surge period of the pandemic and no evidence of offsetting of this deficit until 2021, which suggested that significant numbers of malignancies were not identified 15 …”

“…Regardless of the changes in specimen numbers and the relative increase in the malignancy rates, one study reported an absolute deficit of malignancy cytology cases during the initial surge period of the pandemic and no evidence of offsetting of this deficit until 2021, which suggested that significant numbers of malignancies were not identified. 15 Thyroid surgery was affected by fewer surgeries for cancer and a significant reduction in treatments for advanced-stage thyroid cancer, especially T1bN1a and T3bN1b disease staged according to the World Health Organization TNM staging system. 16 Those numbers were probably related to the finding that the examinations were classified as nonurgent, affecting patient management.…”

The detrimental consequences of two consecutive disasters impacting cytopathology in Ukraine: COVID followed by the war

“…2 This reflected the shift in prioritisation of medical care towards individuals with higher cancer risks or its clinical manifestation. 3,4 The following vaccination and reduction of restrictive measures resulted in the recovery of cytopathology services worldwide, including in Ukraine. 1 At the beginning of 2022, in contrast to most European countries recovering after the COVID-19 restrictions, the Ukrainian healthcare system faced much greater pressure and challenges affecting all fields of medical and laboratory practices including cytopathology.…”

“…Previous studies illuminated the dramatic reduction in the number of cytological samples processed during the “lockdown” period associated with a higher malignancy rate 2 . This reflected the shift in prioritisation of medical care towards individuals with higher cancer risks or its clinical manifestation 3,4 . The following vaccination and reduction of restrictive measures resulted in the recovery of cytopathology services worldwide, including in Ukraine 1 …”