The Negative Impact of COVID-19 Pandemics on the Diagnosis of Lung Diseases in Brazil.

Abstract

Background: COVID-19 pandemics affects the Health system all around the World. Brazil, since the first case in March, reported more than 4.0 million people infected. The pandemic's magnitude made that Hospitals prioritize the care of the secondary respiratory distress syndrome, and all elective diagnosis and treatment have been postponed. This study aimed to assess changes in patient's profiles submitted to lung or pleural biopsies comparing before and during COVID-19 pandemics.Methods: We retrospectively review the data of patients who underwent lung disease diagnostic approaches across April/May 2019 versus April/May 2020. We collect the data about the total cases, demographics, type of procedure, and disease diagnosis. Histological type, stage of the tumors, and molecular profile were also analyzed in cancer cases.Results: The number of total cases and lung biopsies dropped by more than 90% when the 2019/2020 samples were compared. Benign disease faced a more substantial reduction than cancer cases, with emphasis in granulomatous diseases. We had more advanced cases and more squamous cell carcinomas and small cell neuroendocrine carcinomas in the cancer scenario. Low-grade tumors, as carcinoids, suffered a significant reduction. Also, the molecular profile of the tumors drops in absolute numbers. Still, there was an increase of PD-L1 expression, probably because the sample comprises more squamous cell carcinomas and advanced cases.Conclusions: COVID-19 pandemics have a considerable negative impact on the management and diagnosis of lung diseases in Brazil. The consequences can be significant, and implementing a new policy to patients with lung diseases must be managed.