The practice of cytopathology during the era of COVID-19: challenges and changes

Abstract

This paper reviews the challenges faced by cytology laboratories during the COVID-19 pandemic. Various safety guidelines regarding collection, handling, transport and sampling in cytology laboratory are presented. A brief literature overview of adapted changes regarding new safety techniques, processing, sampling techniques implemented by the cytology laboratories in the this part of the world is presented. The use of cytology in COVID-19 patients is discussed. The authors have also tried to present the challenges and changes faced for training and education during this time. Migration from multi-headed scope in-person sign-out to digital based platforms were adapted to continue medical education. The potential long-term implications of these adaptations on cytology services are also touched upon.

Cytopathology Practice in the COVID-19 Era: Focus on Sample Workload

“…In fact, the most remarkable reductions were observed in samples with an expected low risk of malignancy among non-gynecological specimens, such as thyroid, and in gynecological samples. The latter evidence was also confirmed by other experiences from American and British laboratories [16].…”

“…However, timely diagnosis, treatment, and regular follow-ups for certain malignancies are crucial to prolonging the overall survival of advanced cancer patients [27,28]. After the first wave of COVID-19, single institutions experienced a gradual increase in cytological sample volume thanks to the progressive loosening of restrictive measures [16,18]. Now that the world is still in the middle of the pandemic, cytology practice is still struggling to return to the pre-pandemic levels, as the fear of contagion still permeates people's lives.…”

“…In the meantime, continuous monitoring of cytopathology practice is paramount in order to guarantee that at least high-risk oncological patients are properly managed. Finally, considering the massive backlog of patients awaiting cytological testing, we expect a rebound increase in screening and diagnostic procedures in the near future [16].…”

“…Similarly, the pandemic has also affected cytopathology diagnostic activity [10][11][12][13][14][15][16][17][18]. Indeed, since hospitals have been advised to review all scheduled elective procedures to minimize or postpone non-urgent procedures, cytological screening activities and cytological sampling of patients at low risk of malignancy have all been postponed.…”

Technical aspects of the use of cytopathological specimens for diagnosis and predictive testing in malignant epithelial neoplasms of the lung

“…Maintaining laboratory safety during the SARS‐CoV‐2 (COVID‐19) global pandemic has necessitated development of COVID‐19 safe laboratory practice guidelines and changes to the handling of cytology samples (as issued for example by the World Health Organisation or the Centers for Disease Control and Prevention). As respiratory tract samples are considered at high risk of being infectious, 55 attendance at ROSE requires the wearing of full personal protective equipment (PPE) within endoscopy suites (including N95 mask), and consideration of alternative ways of working such as minimising staff attending EBUS‐FNA sessions and avoidance of preparing and staining air‐dried slides 56‐60 …”