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Lagerstam H, Tommola E, Kares S, Kholová I. The Milan system atypia of undetermined significance: 5-year performance data. Cancer Cytopathol 2024. [PMID: 39003586 DOI: 10.1002/cncy.22883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 06/13/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND The objective of this study was to evaluate the diagnostic performance of the category atypia of undetermined significance (AUS) at the authors' institution based on the Milan System for Reporting Salivary Gland Cytopathology. METHODS All AUS cases diagnosed at Fimlab Laboratories between January 1, 2018, and December 31, 2022, were included. Histologic verifications were checked until May 31, 2023. The upper-bound and lower-bound risk of malignancy and risk of neoplasm were calculated. The timelines between the pathology laboratory workflow and patient management were also calculated. RESULTS From 1157 fine-needle aspirations (FNAs), 162 (14.0%) AUS cases were diagnosed in 146 patients, with an average ± standard deviation age of 66.1 ± 14.9 years. There was variation in the AUS percentages, with higher values during the coronavirus disease 2019 pandemic years (15% and 17.5% in 2020 and 2021, respectively). Seventy-five cases (46.3%) had histologic follow-up: 16 were malignant neoplasms, and 36 were benign neoplasms. The upper and the lower bounds of the-risk of malignancy and risk of neoplasm were 21.3% and 69.3% and 9.9% and 32.1%, respectively. The average time from the first FNA with an AUS diagnosis to surgical resection ranged from 6 to 682 days, and the time to the first repeat FNA ranged from 10 to 691 days. CONCLUSIONS The results indicated higher percentages of AUS cases compared with the reference value, which may be attributed to the impact of the coronavirus disease 2019 pandemic. The risk of malignancy calculated in this study was closer to the reference value from the first edition of the Milan System for Reporting Salivary Gland Cytopathology compared with the second edition.
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Affiliation(s)
- Henri Lagerstam
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Pathology, Fimlab Laboratories, Tampere, Finland
| | - Erkka Tommola
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Pathology, Fimlab Laboratories, Tampere, Finland
| | - Saara Kares
- Pathology, Fimlab Laboratories, Tampere, Finland
| | - Ivana Kholová
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Pathology, Fimlab Laboratories, Tampere, Finland
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Jennings EB, Percarpio RB, Tafe LJ, Demidenko E, Levy J, Gutmann EJ, Marotti JD. Does ROSE matter? Evaluation of final diagnostic, PD-L1 immunohistochemistry, and molecular testing yields of CT-guided lung biopsies performed before and after the onset of the COVID-19 pandemic. J Am Soc Cytopathol 2024; 13:263-271. [PMID: 38677893 DOI: 10.1016/j.jasc.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 03/03/2024] [Accepted: 03/23/2024] [Indexed: 04/29/2024]
Abstract
INTRODUCTION The onset of the COVID-19 pandemic, with urgent implementation of safety protocols limiting the number of on-site personnel, essentially terminated the use of rapid on-site evaluation (ROSE) for computed tomography (CT)--guided lung biopsies at our institution. The diminished use of ROSE during the pandemic prompted us to reevaluate the potential value of ROSE for CT-guided lung biopsies. MATERIALS AND METHODS We retrospectively identified all CT-guided lung biopsies from 2017 to 2022. Associations between the use of ROSE, adequate diagnostic and ancillary testing (programmed death-ligand 1 immunohistochemistry and next-generation sequencing) outcomes, and other factors such as the number of passes performed and lesion size, were evaluated. RESULTS Nine hundred twelve CT-guided lung biopsies were performed from 2017 to 2022; 171 (19%) utilized ROSE. The use of ROSE had been steadily decreasing prior to the pandemic but was essentially eliminated with the onset of the pandemic. By univariable analysis, the employment of ROSE was more likely to be associated with an adequate final diagnosis (odds ratio = 2.14, 95% confidence interval: [1.24-3.70], P = 0.006) and successful molecular testing (odds ratio = 2.16, 95% confidence interval: [1.11-4.21], P = 0.024). However, those associations were not present in multivariable analyses that incorporated the number of passes performed or lesion size. There were no differences in diagnostic adequacy or ancillary testing yields when comparing the periods 2017-2019 and 2020-2022, despite declining use of ROSE. CONCLUSIONS If ROSE is not requested for CT-guided lung biopsies, proceduralists should err on the side of performing more, rather than fewer, passes, particularly for smaller lesions.
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Affiliation(s)
- Emma B Jennings
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Robert B Percarpio
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Department of Radiology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Laura J Tafe
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Eugene Demidenko
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Joshua Levy
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Department of Dermatology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Edward J Gutmann
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Jonathan D Marotti
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
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Calapkulu M, Sencar ME, Ozturk Unsal I, Sakiz D, Tekinyildiz M, Ozbek M, Cakal E. The effect of COVID-19 pandemic restrictions on the management of differentiated thyroid cancer in Turkey: a single tertiary centre experience. Eur Arch Otorhinolaryngol 2024; 281:2587-2595. [PMID: 38347198 DOI: 10.1007/s00405-024-08496-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/22/2024] [Indexed: 04/18/2024]
Abstract
PURPOSE Many countries have implemented unprecedented health measures since the World Health Organisation declared the novel coronavirus disease 2019 (COVID-19) a global pandemic. These measures have resulted in delays in the diagnosis of differentiated thyroid cancer (DTC). However, there is limited data on the impact of restrictions imposed during the pandemic on DTC management. Thus, the aim of this study is to analyse the clinicopathological and follow-up data of DTC patients diagnosed before and during the COVID-19 outbreak. METHODS This retrospective study included 191 DTC patients that were diagnosed between December 2018 and June 2021. The patients were divided into two groups: patients diagnosed before (December 2018 to February 2020) and during (March 2020 to June 2021) the COVID-19 pandemic. The clinicopathological and follow-up data between the two groups were compared. RESULTS Similar preoperative cytology results were obtained from the two groups. No difference with regard to tumour size, lymphovascular invasion and extrathyroidal invasion was observed between the two groups. While the American Thyroid Association risk stratification was similar between the two groups, radioactive iodine (RAI) therapy was applied less during the COVID-19 period. Although RAI therapy was administered at a lower rate during the COVID-19 period, the recurrence rates among patients after two years of follow-up were similar to those during the pre-COVID-19 period. CONCLUSION Although the COVID-19 pandemic restrictions during the pandemic period caused difficulties in the management of DTC patients, this did not negatively affect their prognosis. These findings can confirm the applicability of active surveillance in DTC patients and may help change the real-life treatment practices in selected low-risk DTC patients.
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Affiliation(s)
- Murat Calapkulu
- Department of Endocrinology and Metabolism, University of Health Sciences Diskapi Yildirim Beyazit Training and Research Hospital, Sehit Omer Halisdemir Avenue, 06110, Ankara, Turkey.
| | - Muhammed Erkam Sencar
- Department of Endocrinology and Metabolism, University of Health Sciences Diskapi Yildirim Beyazit Training and Research Hospital, Sehit Omer Halisdemir Avenue, 06110, Ankara, Turkey
| | - Ilknur Ozturk Unsal
- Department of Endocrinology and Metabolism, University of Health Sciences Diskapi Yildirim Beyazit Training and Research Hospital, Sehit Omer Halisdemir Avenue, 06110, Ankara, Turkey
| | - Davut Sakiz
- Department of Endocrinology and Metabolism, Mardin Training and Research Hospital, Mardin, Turkey
| | - Merve Tekinyildiz
- Department of Internal Medicine, University of Health Sciences Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Mustafa Ozbek
- Department of Endocrinology and Metabolism, University of Health Sciences Diskapi Yildirim Beyazit Training and Research Hospital, Sehit Omer Halisdemir Avenue, 06110, Ankara, Turkey
| | - Erman Cakal
- Department of Endocrinology and Metabolism, University of Health Sciences Diskapi Yildirim Beyazit Training and Research Hospital, Sehit Omer Halisdemir Avenue, 06110, Ankara, Turkey
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Pallari CT, Achilleos S, Quattrocchi A, Gabel J, Critselis E, Athanasiadou M, Rahmanian Haghighi MR, Papatheodorou S, Liu T, Artemiou A, Rodriguez-Llanes JM, Bennett CM, Zimmermann C, Schernhammer E, Bustos Sierra N, Ekelson R, Lobato J, Macedo L, Mortensen LH, Critchley J, Goldsmith L, Denissov G, Le Meur N, Kandelaki L, Athanasakis K, Binyaminy B, Maor T, Stracci F, Ambrosio G, Davletov K, Glushkova N, Martial C, Chan Sun M, Hagen TP, Chong M, Barron M, Łyszczarz B, Erzen I, Arcos Gonzalez P, Burström B, Pidmurniak N, Verstiuk O, Huang Q, Polemitis A, Charalambous A, Demetriou CA. Magnitude and determinants of excess total, age-specific and sex-specific all-cause mortality in 24 countries worldwide during 2020 and 2021: results on the impact of the COVID-19 pandemic from the C-MOR project. BMJ Glob Health 2024; 9:e013018. [PMID: 38637119 PMCID: PMC11029481 DOI: 10.1136/bmjgh-2023-013018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 01/06/2024] [Indexed: 04/20/2024] Open
Abstract
INTRODUCTION To examine the impact of the COVID-19 pandemic on mortality, we estimated excess all-cause mortality in 24 countries for 2020 and 2021, overall and stratified by sex and age. METHODS Total, age-specific and sex-specific weekly all-cause mortality was collected for 2015-2021 and excess mortality for 2020 and 2021 was calculated by comparing weekly 2020 and 2021 age-standardised mortality rates against expected mortality, estimated based on historical data (2015-2019), accounting for seasonality, and long-term and short-term trends. Age-specific weekly excess mortality was similarly calculated using crude mortality rates. The association of country and pandemic-related variables with excess mortality was investigated using simple and multilevel regression models. RESULTS Excess cumulative mortality for both 2020 and 2021 was found in Austria, Brazil, Belgium, Cyprus, England and Wales, Estonia, France, Georgia, Greece, Israel, Italy, Kazakhstan, Mauritius, Northern Ireland, Norway, Peru, Poland, Slovenia, Spain, Sweden, Ukraine, and the USA. Australia and Denmark experienced excess mortality only in 2021. Mauritius demonstrated a statistically significant decrease in all-cause mortality during both years. Weekly incidence of COVID-19 was significantly positively associated with excess mortality for both years, but the positive association was attenuated in 2021 as percentage of the population fully vaccinated increased. Stringency index of control measures was positively and negatively associated with excess mortality in 2020 and 2021, respectively. CONCLUSION This study provides evidence of substantial excess mortality in most countries investigated during the first 2 years of the pandemic and suggests that COVID-19 incidence, stringency of control measures and vaccination rates interacted in determining the magnitude of excess mortality.
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Affiliation(s)
- Chryso Th Pallari
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - Souzana Achilleos
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - Annalisa Quattrocchi
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - John Gabel
- Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Elena Critselis
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - Maria Athanasiadou
- Health Monitoring Unit, Government of the Republic of Cyprus Ministry of Health, Nicosia, Cyprus
| | | | - Stefania Papatheodorou
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Tianyu Liu
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Andreas Artemiou
- School of Information Technologies, University of Limassol, Limassol, Cyprus
| | | | - Catherine M Bennett
- Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
| | - Claudia Zimmermann
- Department of Epidemiology, Medical University of Vienna Center for Public Health, Vienna, Austria
| | - Eva Schernhammer
- Department of Epidemiology, Medical University of Vienna Center for Public Health, Vienna, Austria
| | | | - Reindert Ekelson
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Jackeline Lobato
- Department of Epidemiology and Biostatistics, Institute of Collective Health (ISC), Federal Fluminense University, Niteroi, Brazil
| | - Laylla Macedo
- Institute of Studies in Collective Health (IESC), Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Julia Critchley
- Population Health Research Institute, St George's University of London, London, UK
| | - Lucy Goldsmith
- Division of Health Services Research and Management, School of Health and Psychological Sciences, University of London, City, London, UK
| | - Gleb Denissov
- Department of Registries, National Institute for Health Development, Tallinn, Estonia
| | - Nolwenn Le Meur
- UMR CNRS 6051 - INSERM U1309, Ecole des Hautes Etudes en Santé Publique, Rennes, France
| | - Levan Kandelaki
- Department of Medical Statistics, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Kostas Athanasakis
- Laboratory for Health Technology Assessment, University of West Attica, Athens, Greece
| | - Binyamin Binyaminy
- Israeli Center of Disease Control, State of Israel Ministry of Health, Ramat Gan, Israel
| | - Tamar Maor
- Israeli Center of Disease Control, State of Israel Ministry of Health, Ramat Gan, Israel
| | - Fabrizio Stracci
- Department of Medicine, Public Health Section, University of Perugia, School of Medicine, Perugia, Italy
| | - Giuseppe Ambrosio
- Department of Cardiology, University of Perugia School of Medicine, Perugia, Italy
| | - Kairat Davletov
- Rector Administration, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Nataliya Glushkova
- Department of Epidemiology, Evidence-Based Medicine and Biostatistics, Al-Farabi Kazakh National University, Almaty, Kazakhstan
| | - Cyndy Martial
- Department of Medicine, University of Mauritius Faculty of Science, Reduit, Mauritius
| | - Marie Chan Sun
- Department of Medicine, University of Mauritius Faculty of Science, Reduit, Mauritius
| | - Terje P Hagen
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Mario Chong
- Departamento de Ingeniería, Universidad del Pacifico, Lima, Peru
| | - Manuel Barron
- Departamento de Economia, Universidad del Pacifico, Lima, Peru
| | - Błażej Łyszczarz
- Department of Health Economics, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Ivan Erzen
- Public Health School, National Institute of Public Health of the Republic of Slovenia, Ljubljana, Slovenia
| | - Pedro Arcos Gonzalez
- Unit for Research in Emergency and Disaster, Department of Medicine, University of Oviedo, Oviedo, Spain
| | - Bo Burström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Nataliia Pidmurniak
- Department of Internal Medicine, Bogomolets National Medical University, Kyiv, Ukraine
| | - Olesia Verstiuk
- Department of Medical Sciences, University of Nicosia Medical School, Nicosia, Cyprus
| | - Qian Huang
- Center for Rural Health Research, College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | | | | | - Christiana A Demetriou
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
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de Andrade Natal R, Bedin AR, Giongo AA, Dias EM, Paschoalini RB, Volpato AHC, Melo ALAD, Santos CDC, Delgado ALJ, Dufloth RM, Soares FA, da Cunha Santos G. Thyroid FNA cytology: Impact of the COVID-19 pandemic and vaccination in a Brazilian series. Cancer Cytopathol 2024; 132:22-29. [PMID: 37747447 DOI: 10.1002/cncy.22763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 07/08/2023] [Accepted: 07/17/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND The coronavirus disease 2019 pandemic prompted changes in medical practice, with a reduction in cytopathology volumes and a relative increase in the malignancy rate during lockdown and the initial postlockdown period. To date, no study has evaluated the impact of these changes on the volume of rapid on-site evaluation (ROSE) or on the frequency of cases according to The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) categories after vaccination. METHODS Ultrasound-guided thyroid fine-needle aspiration (FNA) and ROSE assessments performed from January 2019 to May 2022 were evaluated retrospectively according to TBSRTC categories for three periods: prepandemic (period 1), from transmission to expansion (period 2), and after vaccination (period 3). RESULTS There were 7531 nodules from 5815 patients. FNA cases increased throughout the pandemic despite a drop during lockdown. The frequency of TBSRTC categories changed. Nondiagnostic cases had an increase of 18.1% in period 2 and 76.2% after vaccination compared with prepandemic levels. Malignant cases increased from 2.3% to 4.2% in period 2 and to 5.1% in period 3, representing increases of 83.1% and 121.2%, respectively, compared with period 1. Data corrected by time showed increases in categories IV, V, and VI and a decrease in benign nodules during the two pandemic periods. ROSE was performed in 787 cases during the prepandemic period, and there were decreases of 29.4% and 22.8% in periods 2 and 3, respectively. The ROSE-to-category I ratio was reduced significantly after vaccination. CONCLUSIONS Increased volume with sustained lower benign rates and higher malignant rates before and after vaccination indicate better selection of patients for FNA. A worse adequacy rate was correlated with a decrease in the number of ROSE assessments.
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Affiliation(s)
- Rodrigo de Andrade Natal
- Instituto D'Or de Pesquisa e Ensino (IDOR), Sao Paulo, Brazil
- Anatomic Pathology, Rede D'Or, Sao Paulo, Brazil
| | | | - Aline Alencar Giongo
- Instituto D'Or de Pesquisa e Ensino (IDOR), Sao Paulo, Brazil
- Anatomic Pathology, Rede D'Or, Sao Paulo, Brazil
| | - Everton Mesquita Dias
- Instituto D'Or de Pesquisa e Ensino (IDOR), Sao Paulo, Brazil
- Anatomic Pathology, Rede D'Or, Sao Paulo, Brazil
| | - Rafael Bispo Paschoalini
- Instituto D'Or de Pesquisa e Ensino (IDOR), Sao Paulo, Brazil
- Anatomic Pathology, Rede D'Or, Sao Paulo, Brazil
| | | | - André Luís Alves de Melo
- Instituto D'Or de Pesquisa e Ensino (IDOR), Sao Paulo, Brazil
- Anatomic Pathology, Rede D'Or, Sao Paulo, Brazil
| | - Caio de Carvalho Santos
- Instituto D'Or de Pesquisa e Ensino (IDOR), Sao Paulo, Brazil
- Anatomic Pathology, Rede D'Or, Sao Paulo, Brazil
| | | | - Rozany Mucha Dufloth
- Instituto D'Or de Pesquisa e Ensino (IDOR), Sao Paulo, Brazil
- Anatomic Pathology, Rede D'Or, Sao Paulo, Brazil
| | - Fernando Augusto Soares
- Instituto D'Or de Pesquisa e Ensino (IDOR), Sao Paulo, Brazil
- Anatomic Pathology, Rede D'Or, Sao Paulo, Brazil
| | - Gilda da Cunha Santos
- Instituto D'Or de Pesquisa e Ensino (IDOR), Sao Paulo, Brazil
- Anatomic Pathology, Rede D'Or, Sao Paulo, Brazil
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Mazidimoradi A, Sabet Birjandi S, Salehiniya H. Effect of coronavirus disease 2019 on diagnosis and treatment of hepatocellular carcinoma: a systematic review. EXPLORATION OF TARGETED ANTI-TUMOR THERAPY 2023; 4:1039-1058. [PMID: 38023991 PMCID: PMC10651356 DOI: 10.37349/etat.2023.00179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 08/28/2023] [Indexed: 12/01/2023] Open
Abstract
Aim Changes in strategies in the coronavirus disease 2019 (COVID-19) crisis and the imposing of restrictions have isolated many vulnerable patients including those with hepatocellular carcinoma (HCC) from routine medical care. This study investigated how the COVID-19 pandemic is affecting the diagnosis and treatment of HCC. Methods An extensive search was conducted in the PubMed, Scopus, and Web of Science databases by using the appropriate keywords: COVID-19, hepatocellular carcinoma, hepatocellular cancer, and MeSH. Studies in English related to the purpose of the study were included in the analysis, and review studies, case reports, letters to editors, comments, and reports were excluded. The quality of the studies was assessed by the "Adapted Newcastle-Ottawa Quality Assessment Scales" checklist. The Endnote X7 software has been used for managing items. Results The final qualitative analysis consisted of 27 articles. During the COVID-19 crisis, HCC diagnosis decreased from 20% to 34.13% compared to pre-crisis. The impact of the COVID-19 pandemic on HCC treatment encompasses a wide range of aspects. Generally, delays in treatment for patients with HCC ranged from more than one month for 21.5% of patients in France, to two months for 26% of patients in Italy, up to 30% in Austria, and 66.7% in Asia-Pacific countries. Conclusions According to the findings, developing and implementing appropriate diagnostic and therapeutic strategies and developing low-cost and high-precision screening programs among high-risk populations seem to be effective in reducing the impact of the COVID-19 pandemic on HCC management.
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Affiliation(s)
- Afrooz Mazidimoradi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz 71348-14336, Iran
| | - Samane Sabet Birjandi
- Department of Midwifery, Birjand Branch Islamic Azad University, Birjand 97178-11111, Iran
| | - Hamid Salehiniya
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand 97178-53577, Iran
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Troncone G. Trends in the practice of molecular cytopathology in response to the COVID pandemic. Cytopathology 2023; 34:417-418. [PMID: 37291942 DOI: 10.1111/cyt.13257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 05/22/2023] [Indexed: 06/10/2023]
Abstract
In the recent pandemic emergency caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), most activities in many areas of medicine have undergone a remarkable reduction. The health emergency has underlined the evolving role of cytopathology that is increasingly playing a remarkable role in providing oncologists and other physicians with timely information on personalised modern treatment of cancer diagnosed by cytological means.
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Affiliation(s)
- Giancarlo Troncone
- Department of Public Health, University of Naples Federico II, Naples, Italy
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Girolami I, Eccher A. Digital diagnostic cytopathology: Has the pandemic brought us closer? Cytopathology 2023; 34:419-422. [PMID: 36721906 DOI: 10.1111/cyt.13214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/17/2023] [Accepted: 01/27/2023] [Indexed: 02/02/2023]
Abstract
The COVID-19 pandemic has acted as a powerful change driver in the field of pathology and has had relevant consequences on the practice of cytopathology, in terms of changes in workload, rates of malignancy, and the performance of cytology. At the same time, regulatory authorities have relaxed their requirements for the deployment of digital pathology for remote diagnostic reporting. However, most of these improvements have concerned digital histopathology. Data from a literature search show that experiences in digital cytopathology during the pandemic have concerned mainly educational and academic activities. From a broader point of view, when searching for all published literature on digital pathology, only a minority of papers deal with cytopathology, but a noticeable increase in publications has been seen in the last 10 years, with an upward trend toward a maximum of papers in 2021. Indeed, the pandemic has led to greater awareness of the possibility of digital for cytopathology as well.
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Affiliation(s)
- Ilaria Girolami
- Department of Pathology, Provincial Hospital of Bolzano (SABES-ASDAA), Bolzano-Bozen, Italy
- Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Salzburg, Austria
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Albino Eccher
- Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
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Caputo A, Caleo A, Cozzolino I, Zeppa P, Ciancia G, Ciliberti V. COVID-19 post-vaccination lymphadenopathy: A review of the use of fine needle aspiration cytology. Cytopathology 2023; 34:423-432. [PMID: 36807950 DOI: 10.1111/cyt.13221] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 02/20/2023]
Abstract
COVID-19 vaccine-associated clinical lymphadenopathy (C19-LAP) and subclinical lymphadenopathy (SLDI), which are mainly detected by 18F-FDG PET-CT, have been observed after the introduction of RNA-based vaccines during the pandemic. Lymph node (LN) fine needle aspiration cytology (FNAC) has been used to diagnose single cases or small series of SLDI and C19-LAP. In this review, clinical and LN-FNAC features of SLDI and C19-LAP are reported and compared to non-Covid (NC)-LAP. A search for studies on C19-LAP and SLDI histopathology and cytopathology was performed on PubMed and Google Scholar, on 11 January 2023. Reports on LN-FNAC of C19-LAP were retrieved. A total of 14 reports, plus one unpublished case of C19-LAP observed in our institution, diagnosed by LN-FNAC were included in a pooled analysis and compared to the corresponding histopathological reports. In total, 26 cases were included in this review, with a mean age of 50.5 years. Twenty-one lymphadenopathies assessed by LN-FNAC were diagnosed as benign, and three cases as atypical lymphoid hyperplasia; the latter were subsequently confirmed as benign (one by repetition of LN-FNAC, two by histological control). One case of mediastinal lymphadenopathy in a patient suffering from melanoma was reported as reactive granulomatous inflammation, while one unsuspected case was diagnosed as metastasis from melanoma. In all cases, the cytological diagnoses were confirmed by follow-up or excisional biopsy. The high diagnostic value of LN-FNAC in excluding malignant processes was extremely useful in this context and may be particularly valuable when CNB or histological excisions are difficult to perform, as was the case during Covid lockdowns.
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Affiliation(s)
- Alessandro Caputo
- UOC di Anatomia Patologica, Azienda Ospedaliera Universitaria, San Giovanni di Dio e Ruggi d'Aragona, University of Salerno (IT), Salerno, Italy
| | - Alessia Caleo
- UOC di Anatomia Patologica, Azienda Ospedaliera Universitaria, San Giovanni di Dio e Ruggi d'Aragona, University of Salerno (IT), Salerno, Italy
| | - Immacolata Cozzolino
- Dipartimento di Salute Mentale e Fisica e Medicina, Università degli studi della Campania Luigi Vanvitelli, Naples (IT), Naples, Italy
| | - Pio Zeppa
- UOC di Anatomia Patologica, Azienda Ospedaliera Universitaria, San Giovanni di Dio e Ruggi d'Aragona, University of Salerno (IT), Salerno, Italy
| | - Giuseppe Ciancia
- UOC di Anatomia Patologica, Azienda Ospedaliera Universitaria, San Giovanni di Dio e Ruggi d'Aragona, University of Salerno (IT), Salerno, Italy
| | - Valeria Ciliberti
- UOC di Anatomia Patologica, Azienda Ospedaliera Universitaria, San Giovanni di Dio e Ruggi d'Aragona, University of Salerno (IT), Salerno, Italy
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10
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Sulaieva O, Dudin O, Botsun P, Pischanska S, Karpachova V, Omelianenko I, Burkatska M, Panko I, Meged T, Solodka Y, Haidamak O, Prokopenko T, Morozov B, Rybalchenko T, Dzerzhinsky M, Falalyeyeva T, Kobyliak N. The detrimental consequences of two consecutive disasters impacting cytopathology in Ukraine: COVID followed by the war. Cytopathology 2023; 34:442-449. [PMID: 37060237 DOI: 10.1111/cyt.13236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/13/2023] [Accepted: 03/28/2023] [Indexed: 04/16/2023]
Abstract
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.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Taras Rybalchenko
- Educational-Scientific Center "Institute of Biology and Medicine" Taras Shevchenko National University of Kyiv, Kyiv, Ukraine
| | - Mykola Dzerzhinsky
- Educational-Scientific Center "Institute of Biology and Medicine" Taras Shevchenko National University of Kyiv, Kyiv, Ukraine
| | - Tetyana Falalyeyeva
- Medical Laboratory CSD, Kyiv, Ukraine
- Educational-Scientific Center "Institute of Biology and Medicine" Taras Shevchenko National University of Kyiv, Kyiv, Ukraine
| | - Nazarii Kobyliak
- Medical Laboratory CSD, Kyiv, Ukraine
- Bogomolets National Medical University, Kyiv, Ukraine
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11
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Lazure P, Sireci A, Subbiah V, Murray S, Grohé C, Sherman SI, Kelly E, Bubach P, Péloquin S. Challenges in diagnosis and biomarker testing for RET-altered lung and thyroid cancer care: an international mixed-method study. BMC MEDICAL EDUCATION 2023; 23:410. [PMID: 37277734 DOI: 10.1186/s12909-023-04396-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 05/25/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND The introduction of new targeted therapies for RET-altered lung and thyroid cancers (LC/TC) has impacted pathologists' practice by making genomic testing more relevant. Variations in health systems and treatment access result in distinct clinical challenges and barriers. This study aimed to assess practice gaps and challenges experienced by pathologists involved in the diagnosis of RET-altered LC/TC, including biomarker testing, to inform educational solutions. METHODS Pathologists in Germany, Japan, the UK, and US participated in this ethics-approved mixed-methods study, which included interviews and surveys (data collected January-March 2020). Qualitative data was thematically analysed, quantitative data was analysed with chi-square and Kruskal-Wallis H-tests, and both were triangulated. RESULTS A total of 107 pathologists took part in this study. Knowledge gaps were reported regarding genomic testing for LC/TC in Japan (79/60%), the UK (73/66%), and the US (53/30%). Skill gaps were reported when selecting genomic biomarker tests to diagnose TC in Japan (79%), the UK (73%) and US (57%) and when performing specific biomarker tests, especially in Japan (82% for RET) and in the UK (75% for RET). Japanese participants (80%) reported uncertainty about what information to share with the multidisciplinary team to ensure optimal patient-centered care. At the time of data collection, pathologists in Japan faced access barriers to using RET biomarker tests: only 28% agreed that there are relevant RET genomic biomarker tests available in Japan, versus 67% to 90% in other countries. CONCLUSIONS This study identified areas where pathologists need additional continuing professional development opportunities to enhance their competencies and better support delivery of care to patients with RET-altered lung or thyroid tumours. Addressing identified gaps and improving competencies of pathologists in this field should be emphasised in continuing medical education curricula and through quality improvement initiatives. Strategies deployed on an institutional and health system level should aim to improve interprofessional communication and genetic biomarker testing expertise.
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Affiliation(s)
- Patrice Lazure
- AXDEV Group Inc., 8, Place du Commerce, Suite 210, Brossard, Québec, J4W 3H2, Canada.
| | | | - Vivek Subbiah
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Suzanne Murray
- AXDEV Group Inc., 8, Place du Commerce, Suite 210, Brossard, Québec, J4W 3H2, Canada
| | | | - Steven I Sherman
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Sophie Péloquin
- AXDEV Group Inc., 8, Place du Commerce, Suite 210, Brossard, Québec, J4W 3H2, Canada
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12
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Rossi ED, Pantanowitz L. Effect of COVID-19 restrictions on thyroid cytopathology: delay in the diagnosis of indeterminate lesions. Lancet Diabetes Endocrinol 2023; 11:377-379. [PMID: 37127042 DOI: 10.1016/s2213-8587(23)00089-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 03/27/2023] [Indexed: 05/03/2023]
Affiliation(s)
- Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Catholic University of Sacred Heart, 00168 Rome, Italy.
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13
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Fernandes S, Sosa-Napolskij M, Lobo G, Silva I. Relation of COVID-19 with liver diseases and their impact on healthcare systems: The Portuguese case. World J Gastroenterol 2023; 29:1109-1122. [PMID: 36844137 PMCID: PMC9950868 DOI: 10.3748/wjg.v29.i6.1109] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/18/2022] [Accepted: 12/30/2022] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND The impact caused by the coronavirus disease 2019 (COVID-19) on the Portuguese population has been addressed in areas such as clinical manifestations, frequent comorbidities, and alterations in consumption habits. However, comorbidities like liver conditions and changes concerning the Portuguese population's access to healthcare-related services have received less attention. AIM To (1) Review the impact of COVID-19 on the healthcare system; (2) examine the relationship between liver diseases and COVID-19 in infected individuals; and (3) investigate the situation in the Portuguese population concerning these topics. METHODS For our purposes, we conducted a literature review using specific keywords. RESULTS COVID-19 is frequently associated with liver damage. However, liver injury in COVID-19 individuals is a multifactor-mediated effect. Therefore, it remains unclear whether changes in liver laboratory tests are associated with a worse prognosis in Portuguese individuals with COVID-19. CONCLUSION COVID-19 has impacted healthcare systems in Portugal and other countries; the combination of COVID-19 with liver injury is common. Previous liver damage may represent a risk factor that worsens the prognosis in individuals with COVID-19.
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Affiliation(s)
- Sara Fernandes
- Instituto de Ciências Biomédicas Abel Salazar da Universidade do Porto (ICBAS-UP), Porto 4050-313, Portugal
| | - Milaydis Sosa-Napolskij
- CINTESIS@RISE, Center for Health Technology and Services Research at The Associate Laboratory RISE–Health Research Network, Faculty of Medicine of The University of Porto, Porto 4200-219, Portugal
| | - Graça Lobo
- Laboratory of Pharmacology and Neurobiology–Department of Immuno-physiology and Pharmacology, Instituto de Ciências Biomédicas Abel Salazar da Universidade do Porto (ICBAS-UP), Porto 4050-313, Portugal
- Center for Drug Discovery and Innovative Medicines (MedInUP), Instituto de Ciências Biomédicas Abel Salazar da Universidade do Porto (ICBAS-UP), Porto 4050-313, Portugal
| | - Isabel Silva
- Laboratory of Pharmacology and Neurobiology–Department of Immuno-physiology and Pharmacology, Instituto de Ciências Biomédicas Abel Salazar da Universidade do Porto (ICBAS-UP), Porto 4050-313, Portugal
- Center for Drug Discovery and Innovative Medicines (MedInUP), Instituto de Ciências Biomédicas Abel Salazar da Universidade do Porto (ICBAS-UP), Porto 4050-313, Portugal
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14
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Grani G, Ciotti L, Del Gatto V, Montesano T, Biffoni M, Giacomelli L, Sponziello M, Pecce V, Verrienti A, Filetti S, Durante C. The legacy of the COVID-19 pandemics for thyroid cancer patients: towards the application of clinical practice recommendations. Endocrine 2023; 79:45-48. [PMID: 35857273 PMCID: PMC9298162 DOI: 10.1007/s12020-022-03132-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/30/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Giorgio Grani
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Laura Ciotti
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Valeria Del Gatto
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Teresa Montesano
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Marco Biffoni
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Laura Giacomelli
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Marialuisa Sponziello
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Valeria Pecce
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Antonella Verrienti
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Sebastiano Filetti
- School of Health, UNITELMA Sapienza University of Rome, Piazza Sassari, 4, 00161, Rome, Italy
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
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15
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Nanoparticle-Mediated Delivery of STAT3 Inhibitors in the Treatment of Lung Cancer. Pharmaceutics 2022; 14:pharmaceutics14122787. [PMID: 36559280 PMCID: PMC9781630 DOI: 10.3390/pharmaceutics14122787] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/05/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022] Open
Abstract
Lung cancer is a common malignancy worldwide, with high morbidity and mortality. Signal transducer and activator of transcription 3 (STAT3) is an important transcription factor that not only regulates different hallmarks of cancer, such as tumorigenesis, cell proliferation, and metastasis but also regulates the occurrence and maintenance of cancer stem cells (CSCs). Abnormal STAT3 activity has been found in a variety of cancers, including lung cancer, and its phosphorylation level is associated with a poor prognosis of lung cancer. Therefore, the STAT3 pathway may represent a promising therapeutic target for the treatment of lung cancer. To date, various types of STAT3 inhibitors, including natural compounds, small molecules, and gene-based therapies, have been developed through direct and indirect strategies, although most of them are still in the preclinical or early clinical stages. One of the main obstacles to the development of STAT3 inhibitors is the lack of an effective targeted delivery system to improve their bioavailability and tumor targetability, failing to fully demonstrate their anti-tumor effects. In this review, we will summarize the recent advances in STAT3 targeting strategies, as well as the applications of nanoparticle-mediated targeted delivery of STAT3 inhibitors in the treatment of lung cancer.
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16
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Gürel A, Baylan B, Keleş İ, Demirbaş A, Karalar M, Gerçek O, Öztekin Ü, Özen A, Ulus İ, Sönmez SZ, Erşekerci E, Çift A, Doğan AE, Ekenci BY, Bayraktar C, Karadağ MA. Effects of the COVID-19 Pandemic on Bladder Cancer Diagnosis and Treatment Processes; A Turkish Multicenter Study. JOURNAL OF UROLOGICAL SURGERY 2022. [DOI: 10.4274/jus.galenos.2022.2021.0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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17
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Impact of COVID-19 Pandemic on Thyroid Surgery in a University Hospital in South Korea. Cancers (Basel) 2022; 14:cancers14174338. [PMID: 36077872 PMCID: PMC9454546 DOI: 10.3390/cancers14174338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/22/2022] [Accepted: 08/31/2022] [Indexed: 11/17/2022] Open
Abstract
The COVID-19 pandemic has changed healthcare systems around the world. Medical personnel concentrated on infectious disease management and treatments for non-emergency diseases and scheduled surgeries were delayed. We aimed to investigate the change in the severity of thyroid cancer before and after the outbreak of COVID-19 in Korea. We collected three years of data (2019, 2020, and 2021) on patients who received thyroid surgery in a university hospital in South Korea and grouped them as "Before COVID-19", "After COVID-19 1-year" and "After COVID-19 2-years". The total number of annual outpatients declined significantly after the outbreak of COVID-19 in both new (1303, 939, and 1098 patients) and follow-up patients (5584, 4609, and 4739 patients). Clinical characteristics, including age, sex, BMI, preoperative cytology results, surgical extent, and final pathologic diagnosis, were not significantly changed after the outbreak of COVID-19. However, the number of days from the first visit to surgery was significantly increased (38.3 ± 32.2, 58.3 ± 105.2, 47.8 ± 124.7 days, p = 0.027). Papillary thyroid carcinoma (PTC) patients showed increased proportions of extrathyroidal extension, lymphatic invasion, vascular invasion, and cervical lymph node metastasis. Increased tumor size was observed in patients with follicular tumor (3.5 ± 2.2, 4.0 ± 1.9, 4.3 ± 2.3 cm, p = 0.019). After the COVID-19 outbreak, poor prognostic factors for thyroid cancer increased, and an increase in the size of follicular tumors was observed. Due to our study being confined to a single tertiary institution in Incheon city, Korea, nationwide studies that include primary clinics should be required to identify the actual impact of COVID-19 on thyroid disease treatment.
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18
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The impact of COVID-19 on radiological findings in patients accessing the emergency department: a multicentric study. Pol J Radiol 2022; 87:e415-e420. [PMID: 35979149 PMCID: PMC9373861 DOI: 10.5114/pjr.2022.118659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/02/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose The aim of this multicentric study is to illustrate how the COVID-19 pandemic lockdown affected the workload and outcomes of radiological examinations in emergency radiology. Material and methods The exams performed in the radiology departments of 4 Italian hospitals during 3 weeks of the Italian lockdown were retrospectively reviewed and compared to the exams conducted during the same period in 2019. Only exams from the emergency department (ED) were included. Two radiologists from each hospital defined the cases as positive or negative findings, based on independent blind readings of the imaging studies. In the case of differences in the evaluation, consensus was reached amongst them via discussion. Continuous measurements are presented as median and interquartile range, while categorical measurements are presented as frequency and percentage; p-values were calculated using the t-test, Mann-Whitney test, and the c2 test. Results There were 745 patients (53% male; 62 years [44-78]) who underwent radiological examinations in 2020 vs. 2623 (52% male; 56 years [35-76]) in 2019 (p < 0.001). Furthermore, the total number of ED exams dropped from 3206 (2019) to 939 (2020), with a relative increase of CT examinations from 23% to 33% (p < 0.001). The percentage of patients with a positive finding was significantly higher in 2020 (355, 48%) compared to 2019 (684, 26%) (p < 0.001). Conclusions Our findings show that despite the reduction of emergency radiological examinations, there was a rela-tive increase in the number of positive cases. These significant findings are crucial to ensure better organization of radiology departments and improve patient management during similar health emergencies in the future.
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19
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Žarković M, Perros P, Ćirić J, Beleslin B, Stojanović M, Stojković M, Miletić M, Janić T. Health care access of thyroid disease patients in Serbia during the COVID-19 pandemic. J Endocrinol Invest 2022; 45:1521-1526. [PMID: 35325447 PMCID: PMC8944403 DOI: 10.1007/s40618-022-01787-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/14/2022] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of this study was to assess the impact of repurposing health care facilities in response to COVID-19 on the access of patients with thyroid disease to health care. METHODS This study consisted of a web-based survey. The survey was anonymous and consisted of forty questions. RESULTS This survey included 206 respondents. 91.3% of the respondents had health insurance through the Republic Fund of Health Insurance, 9.7% had private or both health insurances, and 3.4% did not have any health insurance. A significant proportion of respondents (60.4%) had to switch from public to private health care to reach a physician and 73.8% had to switch from public to private laboratories. For the 91.9%, this was perceived as a financial burden. Before the pandemic, 83.1% of respondents reported regular follow-up by physicians, which decreased to 44.9% during the pandemic (p < 0.01). 76.3% of the respondents regarded that their thyroid disease was managed optimally before the pandemic, while this figure declined to only 48% during the pandemic (p < 0.01). CONCLUSIONS The COVID-19 pandemic disrupted the medical care of thyroid patients in Serbia. For the patients treated in the public health care system, access to general practice was hindered, while access to specialist care was disrupted. It led to a switch from public to private health care, which was perceived as a financial burden for almost all the respondents. However, private health care proved to be an important safety net when the public system was overwhelmed.
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Affiliation(s)
- M Žarković
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
- Clinic of Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Centre, Dr Subotića starijeg 13, 11000, Belgrade, Serbia.
| | - P Perros
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - J Ćirić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic of Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Centre, Dr Subotića starijeg 13, 11000, Belgrade, Serbia
| | - B Beleslin
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic of Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Centre, Dr Subotića starijeg 13, 11000, Belgrade, Serbia
| | - M Stojanović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic of Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Centre, Dr Subotića starijeg 13, 11000, Belgrade, Serbia
| | - M Stojković
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic of Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Centre, Dr Subotića starijeg 13, 11000, Belgrade, Serbia
| | - M Miletić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic of Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Centre, Dr Subotića starijeg 13, 11000, Belgrade, Serbia
| | - T Janić
- Clinic of Endocrinology, Diabetes and Diseases of Metabolism, University Clinical Centre, Dr Subotića starijeg 13, 11000, Belgrade, Serbia
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20
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Yousefi E, Cibas ES, Mito JK. Quantifying the hidden impact of COVID-19 pandemic: The cytology perspective. Cancer Cytopathol 2022; 130:824-832. [PMID: 35749134 PMCID: PMC9349836 DOI: 10.1002/cncy.22613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/16/2022] [Accepted: 05/31/2022] [Indexed: 12/02/2022]
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. The COVID‐19 pandemic has led to dramatic reductions in cytology specimen volumes. Although prior studies have noted an increased rate of malignant diagnoses, our data demonstrate that this did not offset the dramatic reduction in specimen numbers. The COVID‐19 pandemic has contributed to delayed and missed diagnoses of malignancy.
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Affiliation(s)
- Elham Yousefi
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Edmund S Cibas
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jeffrey K Mito
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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21
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Carvalho AS, Brito Fernandes Ó, de Lange M, Lingsma H, Klazinga N, Kringos D. Changes in the quality of cancer care as assessed through performance indicators during the first wave of the COVID-19 pandemic in 2020: a scoping review. BMC Health Serv Res 2022; 22:786. [PMID: 35715795 PMCID: PMC9204363 DOI: 10.1186/s12913-022-08166-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 06/06/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Cancer comprises a high burden on health systems. Performance indicators monitoring cancer outcomes are routinely used in OECD countries. However, the development of process and cancer-pathway based information is essential to guide health care delivery, allowing for better monitoring of changes in the quality of care provided. Assessing the changes in the quality of cancer care during the COVID-19 pandemic requires a structured approach considering the high volume of publications. This study aims to summarize performance indicators used in the literature to evaluate the impact of the COVID-19 pandemic on cancer care (January-June 2020) in OECD countries and to assess changes in the quality of care as reported via selected indicators. METHODS Search conducted in MEDLINE and Embase databases. Performance indicators and their trends were collated according to the cancer care pathway. RESULTS This study included 135 articles, from which 1013 indicators were retrieved. Indicators assessing the diagnostic process showed a decreasing trend: from 33 indicators reporting on screening, 30 (91%) signalled a decrease during the pandemic (n = 30 indicators, 91%). A reduction was also observed in the number of diagnostic procedures (n = 64, 58%) and diagnoses (n = 130, 89%). The proportion of diagnoses in the emergency setting and waiting times showed increasing trends (n = 8, 89% and n = 14, 56%, respectively). A decreasing trend in the proportion of earliest stage cancers was reported by 63% of indicators (n = 9), and 70% (n = 43) of indicators showed an increasing trend in the proportion of advanced-stage cancers. Indicators reflecting the treatment process signalled a reduction in the number of procedures: 79%(n = 82) of indicators concerning surgeries, 72%(n = 41) of indicators assessing radiotherapy, and 93%(n = 40) of indicators related to systemic therapies. Modifications in cancer treatment were frequently reported: 64%(n = 195) of indicators revealed changes in treatment. CONCLUSIONS This study provides a summary of performance indicators used in the literature to assess the cancer care pathway from January 2020 to June 2020 in OECD countries, and the changes in the quality of care signalled by these indicators. The trends reported inform on potential bottlenecks of the cancer care pathway. Monitoring this information closely could contribute to identifying moments for intervention during crises.
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Affiliation(s)
- Ana Sofia Carvalho
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands.
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Óscar Brito Fernandes
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Mats de Lange
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
| | - Hester Lingsma
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Niek Klazinga
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Dionne Kringos
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
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22
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Duarte MB, Argenton JL, Carvalheira JB. Impact of COVID-19 in Cervical and Breast Cancer Screening and Systemic Treatment in São Paulo, Brazil: An Interrupted Time Series Analysis. JCO Glob Oncol 2022; 8:e2100371. [PMID: 35696624 PMCID: PMC9225667 DOI: 10.1200/go.21.00371] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE COVID-19 caused a disruption in cancer management around the world, resulting in an estimated excess burden secondary to screening disruption and excess lag time for treatment initiation. METHODS We gathered information from primary reimbursement data sets of the public health system of São Paulo, Brazil, from April 2020 to November 2021, and compared these data with those of the pre–COVID-19 period. We used an interrupted time series model to estimate the effect of the COVID-19 pandemic on the rate of key procedures of breast and cervical cancer health care chain. RESULTS We estimated that 1,149,727, 2,693, and 713,616 pap smears, conizations, and mammograms, respectively, were missed or delayed during the COVID-19 pandemic, compared with those in the years immediately before the COVID-19 stay-at-home restrictions. Specifically, we observed an acute decrease of procedures after the COVID-19 stay-at-home restrictions, with a trend to recovery in the long term. Regarding the systemic treatment analysis, we observed a 25% reduction in the rate of initiation of adjuvant systemic treatment for early breast cancer (stage I/II). However, we did not find a clear effect on the other settings of systemic treatment for breast cancer. We estimated an excess of 156 patients starting palliative care for cervical cancer after the COVID-19 stay-at-home restrictions. CONCLUSION The COVID-19 pandemic significantly reduced the performance rate of pap smears, conizations, and mammograms. The initiation of adjuvant treatment for early-stage breast cancer was most susceptible to COVID-19's health system disruption. Furthermore, the downward trend of treatment of advanced cervical cancer was interrupted. Therefore, public health policies are urgently needed to decrease the incidence of advanced cervical and breast cancers caused by delayed diagnosis and treatment initiation. The COVID-19 control policies resulted in reduction of cancer patients' delivery of care. This study evaluated the pandemic's influence in key procedures of breast and cervical cancer chain of care in São Paulo, Brazil. We observed a substantial reduction in the number of mammograms, pap smears, and conizations performed since the onset of the COVID-19 pandemic. In addition, stage I and II breast cancer adjuvant treatment presented a reduced realization rate, whereas palliative treatment delivered for advanced cervical cancer increased. Our results support the need for public health policies focused on mitigating the long-term effects of COVID-19 in cancer-related mortality.
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Affiliation(s)
- Mateus B.O. Duarte
- Division of Oncology, Department of Anesthesiology, Oncology and Radiology, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
- Uberlândia Cancer Hospital, Federal University of Uberlândia, UFU, Uberlândia, Minas Gerais, Brazil
| | - Juliana L.P. Argenton
- Fundação de Desenvolvimento da Universidade Estadual de Campinas (FUNCAMP), Campinas, São Paulo, Brazil
| | - José B.C. Carvalheira
- Division of Oncology, Department of Anesthesiology, Oncology and Radiology, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
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23
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Vigliar E, Pisapia P, Dello Iacovo F, Alcaraz‐Mateos E, Alì G, Ali SZ, Baloch ZW, Bellevicine C, Bongiovanni M, Botsun P, Bruzzese D, Bubendorf L, Büttner R, Canberk S, Capitanio A, Casadio C, Cazacu E, Cochand‐Priollet B, D’Amuri A, Davis K, Eloy C, Engels M, Fadda G, Fontanini G, Fulciniti F, Hofman P, Iaccarino A, Ieni A, Jiang XS, Kakudo K, Kern I, Kholova I, Linton McDermott KM, Liu C, Lobo A, Lozano MD, Malapelle U, Maleki Z, Michelow P, Mikula MW, Musayev J, Özgün G, Oznur M, Peiró Marqués FM, Poller D, Pyzlak M, Robinson B, Rossi ED, Roy‐Chowdhuri S, Saieg M, Savic Prince S, Schmitt FC, Seguí Iváñez FJ, Štoos‐Veić T, Sulaieva O, Sweeney BJ, Tuccari G, van Velthuysen M, VanderLaan PA, Vielh P, Viola P, Voorham QJM, Weynand B, Zeppa P, Faquin WC, Pitman MB, Troncone G. COVID-19 pandemic impact on cytopathology practice in the post-lockdown period: An international, multicenter study. Cancer Cytopathol 2022; 130:344-351. [PMID: 35006650 PMCID: PMC9015399 DOI: 10.1002/cncy.22547] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 12/23/2022]
Abstract
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.
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24
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Rabe K, Chauhan A, Holler J, Mettler T, Amin K, Stewart J. Effects of COVID-19 Pandemic on Cytology: Specimen Adequacy in Fine Needle Aspiration of Palpable Head and Neck Masses. J Am Soc Cytopathol 2022; 11:234-240. [PMID: 35610100 PMCID: PMC9015948 DOI: 10.1016/j.jasc.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/07/2022] [Accepted: 04/11/2022] [Indexed: 11/17/2022]
Abstract
Introduction At our institution, palpation-guided fine-needle aspiration (FNA) is performed by the cytopathology service on an outpatient basis at the request of otolaryngologist surgeons. The aim of this study is to assess the effect of COVID lockdown measures on our FNA service with specific focus on adequacy rates. Materials and methods All palpation-guided FNA performed in 2019 to 2020 were identified in our pathology database. Adequacy rates were compared for 3 time periods in 2020: pre-COVID, lockdown, and post-lockdown. Results In 2019, 121 FNAs were performed with 98% (119 of 121) obtained by pathology and only 2% (2 of 121) obtained by surgeons. In 2020, 89 FNAs were performed with 45% (40 of 89) collected by pathologists and 55% (49 of 89) by surgeons. During the pre-COVID period of 2020, 27 FNAs were collected, 85% (23 of 27) by pathologists, 8.7% of these (2 of 23) were nondiagnostic. Of the 4 FNAs performed by surgeons, all were positive for malignancy. During COVID lockdown all 24 FNAs were performed by surgeons with a 50% (12 of 24) nondiagnostic rate. Post-lockdown, with FNA referrals still below pre-COVID levels, surgeons performed 55.3% (21 of 38) of FNAs with 28.6% (6 of 21) non-diagnostic, while pathology performed 44.7% (17 of 38) with an 11.8% (2 of 17) nondiagnostic rate. Conclusions Our FNA service noted significant changes in 2020 as a result of the COVID pandemic. Nondiagnostic rates were significantly increased in 2020 compared with 2019, primarily due to a shift to majority surgeon-performed palpation-guided FNA in the absence of cytopathology service during the lockdown period.
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25
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van Velthuysen MLF, van Eeden S, le Cessie S, de Boer M, van Boven H, Koomen BM, Roozekrans F, Bart J, Timens W, Voorham QJM. Impact of COVID-19 pandemic on diagnostic pathology in the Netherlands. BMC Health Serv Res 2022; 22:166. [PMID: 35139847 PMCID: PMC8826665 DOI: 10.1186/s12913-022-07546-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 01/25/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has a huge impact on healthcare provided. The nationwide pathology registry of the Netherlands, PALGA, offers an outstanding opportunity to measure this impact for diseases in which pathology examinations are involved. METHODS Pathology specimen numbers in 2020 were compared with specimen numbers in 2019 for 5 periods of 4 weeks, representing two lockdowns and the periods in between, taking into account localization, procedure and benign versus malignant diagnosis. RESULTS The largest decrease was seen during the first lockdown (spring 2020), when numbers of pathology reports declined up to 88% and almost all specimen types were affected. Afterwards each specimen type showed its own dynamics with a decrease during the second lockdown for some, while for others numbers remained relatively low during the whole year. Generally, for most tissue types resections, cytology and malignant diagnoses showed less decrease than biopsies and benign diagnoses. A significant but small catch-up (up to 17%) was seen for benign cervical cytology, benign resections of the lower gastro-intestinal tract, malignant skin resections and gallbladder resections. CONCLUSION The COVID-19 pandemic has had a significant effect on pathology diagnostics in 2020. This effect was most pronounced during the first lockdown, diverse for different anatomical sites and for cytology compared with histology. The data presented here can help to assess the consequences on (public) health and provide a starting point in the discussion on how to make the best choices in times of scarce healthcare resources, considering the impact of both benign and malignant disease on quality of life.
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Affiliation(s)
| | - S van Eeden
- Department of Pathology, Erasmus Medical Center, Rotterdam, Netherlands
| | - S le Cessie
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - M de Boer
- Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands
| | - H van Boven
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - B M Koomen
- Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands
| | - F Roozekrans
- Laboratory of Pathology Oost Nederland (LABPON), Hengelo, Netherlands
| | - J Bart
- Dutch Society of Pathology (NVVP), Leiden, Netherlands.,Department of Pathology and Medical Biology, University Medical Center Groningen, Groningen, Netherlands
| | - W Timens
- Dutch Society of Pathology (NVVP), Leiden, Netherlands.,Department of Pathology and Medical Biology, University Medical Center Groningen, Groningen, Netherlands
| | - Q J M Voorham
- Pathologisch Anatomisch Landelijk Geautomatiseerd Archief (PALGA), Houten, Netherlands
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26
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Pisapia P, Pepe F, Gristina V, La Mantia M, Francomano V, Russo G, Iaccarino A, Galvano A. A narrative review on the implementation of liquid biopsy as a diagnostic tool in thoracic tumors during the COVID-19 pandemic. MEDIASTINUM (HONG KONG, CHINA) 2022; 5:27. [PMID: 35118332 PMCID: PMC8794438 DOI: 10.21037/med-21-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 07/13/2021] [Indexed: 12/11/2022]
Abstract
Objective In this review, we evaluate the role of liquid biopsy in managing lung cancer patients during the still ongoing coronavirus disease 2019 (COVID-19) healthcare emergency. Background The novel influenza coronavirus (severe acute respiratory syndrome coronavirus or SARS-CoV-2) has upended several aspects of our lives, including medical activities. In this setting, many routine cancer diagnostic and therapeutic procedures have been suspended, leading to delays in diagnosis, treatments, and, ultimately, increases in cancer mortality rates. Equally drastic has been the impact of COVID-19 on clinical trials, many of which have been stalled or have never begun. This has left many patients who were hoping to receive innovative treatments in a limbo. Although, as of today, the introduction of drastic security measures has been crucially important to contain the pandemic, one cannot ignore the need to continue providing chronically ill patients all the health care they need, in terms of detection, prevention, and treatment. In these unprecedented times, liquid biopsy, more than ever before, may play a relevant role in the adequate management of these frail patients. Methods we performed a deep analysis of the recent international literature published in English on PUBMED in the last six months focused on the impact of SARS-CoV-2 on the management of lung cancer patients, focusing the attention on the role of liquid biopsy. Conclusions COVID-19 pandemic has significantly modified our lives and overall medical practice. In these unprecedented times, liquid biopsy may represent a valid and less time-consuming diagnostic approach than conventional tissue and cytological specimens.
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Affiliation(s)
- Pasquale Pisapia
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Francesco Pepe
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Valerio Gristina
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Maria La Mantia
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | | | - Gianluca Russo
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Antonino Iaccarino
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Antonio Galvano
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
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27
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Arisz RA, Meijer P, Péquériaux NCV, van de Leur SJ, Lukens MV, de Maat MPM, Hollestelle MJ. Impact of COVID-19 pandemic on the quality of test output in haemostasis laboratories. Int J Lab Hematol 2021; 44:407-413. [PMID: 34806301 PMCID: PMC9011814 DOI: 10.1111/ijlh.13760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 10/15/2021] [Accepted: 10/21/2021] [Indexed: 12/15/2022]
Abstract
Introduction The high incidence of thrombotic events in patients with COVID‐19 affects health care worldwide and results in an increased workload in haemostasis laboratories due to more frequent testing of D‐dimer, haemostatic parameters and anti‐Xa tests. However, the impact of this increase in assay requests on the quality of performance in haemostasis laboratories remains unclear. In this study, the impact of the COVID‐19 pandemic on the quality of performance and management of haemostasis laboratories was evaluated. Methods The impact on the quality of performance was studied using external quality assessment data from 2019 to 2020 derived from ECAT surveys. A questionnaire was sent to Dutch haemostasis laboratories to identify challenges and management strategies. Furthermore, the number of assays performed in 2019 and 2020 was supplied by four Dutch hospitals, located in regions with different disease incidence. Results No differences in response rate nor the quality of the measurements were observed between the EQA surveys in 2019 and 2020. The questionnaire results showed a large increase of >25% in the number of test requests for anti‐Xa, D‐dimer and fibrinogen assays in 2020 compared to 2019. Extreme peaks in test requests were also observed in the four evaluated hospitals. Additionally, 84% of the respondents indicated that they had experienced increased work pressure, and increased sick leave was observed in 71% of the participating laboratories. Conclusions The enormous increase in test requests, especially for D‐dimer assays and anti‐Xa activity, did not affect the quality of performance within haemostatic laboratories during the COVID‐19 pandemic.
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Affiliation(s)
- Ryanne A Arisz
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Piet Meijer
- ECAT Foundation (External quality Control for Assays and Tests), Voorschoten, Netherlands
| | - Nathalie C V Péquériaux
- Department of Clinical Chemistry and Hematology, Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands
| | | | - Michaël V Lukens
- Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Moniek P M de Maat
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Martine J Hollestelle
- ECAT Foundation (External quality Control for Assays and Tests), Voorschoten, Netherlands
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Deligiorgi MV, Siasos G, Vakkas L, Trafalis DT. Charting the Unknown Association of COVID-19 with Thyroid Cancer, Focusing on Differentiated Thyroid Cancer: A Call for Caution. Cancers (Basel) 2021; 13:5785. [PMID: 34830939 PMCID: PMC8616091 DOI: 10.3390/cancers13225785] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/10/2021] [Accepted: 11/16/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Conceived of as the "silver lining" of the dark cloud of the coronavirus disease 2019 (COVID-19) pandemic, lessons taught by this catastrophe should be leveraged by medical authorities and policy makers to optimize health care globally. A major lesson is that resilient health systems should absorb sudden shocks incited by overwhelming health emergencies without compromising the continuum of care of chronic diseases, especially of cancer. METHODS The present review dissects the association between COVID-19 and thyroid cancer (TC), especially with differentiated TC (DTC), focusing on available data, knowledge gaps, current challenges, and future perspectives. RESULTS Obesity has been incriminated in terms of both COVID-19 severity and a rising incidence of TC, especially of DTC. The current conceptualization of the pathophysiological landscape of COVID-19-(D)TC association implicates an interplay between obesity, inflammation, immunity, and oxidative stress. Whether COVID-19 could aggravate the health burden posed by (D)TC or vice versa has yet to be clarified. Improved understanding and harnessing of the pathophysiological landscape of the COVID-19-(D)TC association will empower a mechanism-guided, safe, evidence-based, and risk-stratified management of (D)TC in the COVID-19 era and beyond. CONCLUSION A multidisciplinary patient-centered decision-making will ensure high-quality (D)TC care for patients, with or without COVID-19.
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Affiliation(s)
- Maria V. Deligiorgi
- Clinical Pharmacology Unit–Department of Pharmacology, Faculty of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias St., 11527 Athens, Greece; (L.V.); (D.T.T.)
| | - Gerasimos Siasos
- First Department of Cardiology, Hippokration General Hospital of Athens, Faculty of Mediine, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Lampros Vakkas
- Clinical Pharmacology Unit–Department of Pharmacology, Faculty of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias St., 11527 Athens, Greece; (L.V.); (D.T.T.)
| | - Dimitrios T. Trafalis
- Clinical Pharmacology Unit–Department of Pharmacology, Faculty of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias St., 11527 Athens, Greece; (L.V.); (D.T.T.)
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29
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O'Connor E, O'Connor D, Murray D, Quinn AM. Impact of the COVID-19 pandemic on cytopathology services in the West of Ireland. J Clin Pathol 2021; 75:359-360. [PMID: 34518363 DOI: 10.1136/jclinpath-2021-207850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 08/30/2021] [Indexed: 01/12/2023]
Affiliation(s)
- Eoghan O'Connor
- Histopathology, Galway University Hospitals, Galway, Ireland
| | | | - David Murray
- Histopathology, Galway University Hospitals, Galway, Ireland
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30
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Santoro A, Angelico G, Mastrosimini MG, Inzani F, Cianfrini F, Straccia P, Arciuolo D, D'Alessandris N, Scaglione G, Spadola S, Rossi ED, Zannoni GF. Diagnostic impact of safety protocols for processing peritoneal washing specimens during the global pandemic of coronavirus disease 2019: A comparative study from 195 cytological samples. Cytopathology 2021; 33:93-99. [PMID: 34411371 PMCID: PMC8420544 DOI: 10.1111/cyt.13053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/29/2021] [Accepted: 08/17/2021] [Indexed: 12/02/2022]
Abstract
Background The global pandemic of the coronavirus disease 2019 represents a major concern for health services worldwide, and has also induced major changes in cytopathology practice. Aim We aimed to verify the diagnostic performance of cytological evaluation under a new safety protocol during the pandemic compared to the standard pre‐pandemic procedure. We also aimed to assess how cytological diagnoses and sampling were impacted during the pandemic period compared to the pandemic‐free period in 2019. Materials and methods Cytological samples of peritoneal washings taken during the first 10 months of the pandemic emergency in Italy (March 11, 2020 to January 11, 2021) were compared to samples from the preceding 10‐month time frame (May 11, 2019 to March 10, 2020). Results One hundred ninety‐five specimens were analysed in the present study. We observed no noticeable differences in cytological diagnoses during the pandemic period compared to the pre‐pandemic period. The case numbers by diagnostic category for the pre‐pandemic vs pandemic periods, respectively, were as follows: non‐diagnostic, 0 vs 0 cases; negative for malignancy, 86 vs 52 cases; atypia of uncertain significance, 7 vs 1 cases; suspicious for malignancy, 0 vs 2 cases; malignant, 42 vs 4 cases. Conclusion While a consistent reduction in the number of cytological examinations has been observed during the COVID‐19 period, our institutional safety protocol for processing cytological samples did not affect the diagnostic reliability of peritoneal washing cytology.
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Affiliation(s)
- Angela Santoro
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità Operativa Complessa di Gineco-patologia e Patologia Mammaria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giuseppe Angelico
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità Operativa Complessa di Gineco-patologia e Patologia Mammaria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Frediano Inzani
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità Operativa Complessa di Gineco-patologia e Patologia Mammaria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Federica Cianfrini
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità Operativa Complessa di Gineco-patologia e Patologia Mammaria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Patrizia Straccia
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Damiano Arciuolo
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Nicoletta D'Alessandris
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità Operativa Complessa di Gineco-patologia e Patologia Mammaria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giulia Scaglione
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità Operativa Complessa di Gineco-patologia e Patologia Mammaria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Saveria Spadola
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità Operativa Complessa di Gineco-patologia e Patologia Mammaria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gian Franco Zannoni
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Unità Operativa Complessa di Gineco-patologia e Patologia Mammaria, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Istituto di Anatomia Patologica, Università Cattolica del Sacro Cuore, Rome, Italy
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Henderson MK, Afifi N, Kozlakidis Z. Zooming Along Through the Pandemic: Our Experiences with Virtual Biobanking Conferences and Workshops. Biopreserv Biobank 2021; 19:247-249. [PMID: 34348044 DOI: 10.1089/bio.2021.29091.mkh] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Nahla Afifi
- Qatar Biobank for Medical Research, Doha, Qatar
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Abstract
CONTEXT COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has become the most lethal and rapidly moving pandemic since the Spanish influenza of 1918-1920, is associated with thyroid diseases. METHODS References were identified through searches of PubMed and MEDLINE for articles published from Jan 1, 2019 to February 19, 2021 by use of the MeSH terms "hypothyroidism", "hyperthyroidism", "thyroiditis", "thyroid cancer", "thyroid disease", in combination with the terms "coronavirus" and "COVID-19". Articles resulting from these searches and references cited in those articles were reviewed. RESULTS Though preexisting autoimmune thyroid disease appears unlikely to render patients more vulnerable to COVID-19, some reports have documented relapse of Graves' disease (GD) or newly diagnosed GD about 1 month following SARS-CoV-2 infection. Investigations are ongoing to investigate molecular pathways permitting the virus to trigger GD or cause subacute thyroiditis (SAT). While COVID-19 is associated with non-thyroidal illness, it is not clear whether it also increases the risk of developing autoimmune hypothyroidism. The possibility that thyroid dysfunction may also increase susceptibility for COVID-19 infection deserves further investigation. Recent data illustrate the importance of thyroid hormone in protecting the lungs from injury, including that associated with COVID-19. CONCLUSION The interaction between the thyroid gland and COVID-19 is complex and bidirectional. COVID-19 infection is associated with triggering of GD and SAT, and possibly hypothyroidism. Until more is understood regarding the impact of coronavirus on the thyroid gland, it seems advisable to monitor patients with COVID-19 for new thyroid disease or progression of preexisting thyroid disease.
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Affiliation(s)
- Leonidas H Duntas
- Evgenidion Hospital, Unit of Endocrinology, Diabetes, and Metabolism, University of Athens, Athens 11528, Greece
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Ondič O, Černá K, Kinkorová-Luňáčková I, Němcová J, Mejchar B, Chytra J, Bouda J. SARS-CoV-2 RNA may rarely be present in a uterine cervix LBC sample at the asymptomatic early stage of COVID 19 disease. Cytopathology 2021; 32:766-770. [PMID: 34033165 PMCID: PMC8237001 DOI: 10.1111/cyt.12995] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/19/2021] [Accepted: 04/26/2021] [Indexed: 12/12/2022]
Abstract
Objective Currently, it is thought that uterine cervix mucosal samples present a low risk of SARS‐CoV‐2 exposure. So far, there is no evidence of SARS‐CoV‐2 detection in Papanicolaou (Pap) smears. Nevertheless, clinicians could be exposed unaware to the coronavirus while performing and handling a Pap smear. We aimed to retrospectively evaluate the presence of SARS‐CoV‐2 RNA in cervical liquid‐based cytology (LBC) samples in women who tested positive for a nasopharyngeal COVID‐19 PCR test. Methods From our laboratory database, we identified patients with data on a cervical cancer screening LBC sample paired with a positive nasopharyngeal COVID‐19 PCR test. Relevant LBC samples taken within an incubation period of 14 days and post‐onset RNA shedding interval of 25 days were subsequently tested for SARS‐CoV‐2 RNA using RT‐PCR tests. Results The study group consisted of 102 women. Of those, 23 LBC samples were tested. SARS‐CoV‐2 RNA was detected in one LBC sample from a 26‐year‐old asymptomatic woman taken six days before reporting headaches and knee arthralgia with a positive nasopharyngeal SARS‐CoV‐2 RT‐PCR test. Conclusions It is possible to detect SARS‐CoV‐2 RNA in cervical LBC samples at an early asymptomatic stage of COVID‐19. In general, this finding is infrequent in asymptomatic women who tested SARS‐CoV‐2 positive within an incubation of 14 days and a post‐onset RNA shedding period of 25 days. We fully support the current thinking that cervical LBC samples from asymptomatic women pose a low risk of SARS‐CoV‐2 exposure and can be handled in the frame of good microbiological practice and procedures. This is the first dedicated study of the infectious potential of COVID‐19 in PAP smears. It includes one positive liquid‐based cytology sample paired with a positive nasopharyngeal swab RT‐ PCR SARS CoV‐2 test. The significance of this finding is discussed. Finally, the current approach to handling LBC samples is reinforced.
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Affiliation(s)
- Ondrej Ondič
- Department of Pathology, Medical Faculty, Charles University and Charles University Hospital Pilsen, Pilsen, Czech Republic.,Bioptická Laboratoř, s.r.o., Pilsen, Czech Republic
| | - Kateřina Černá
- Department of Pathology, Medical Faculty, Charles University and Charles University Hospital Pilsen, Pilsen, Czech Republic.,Bioptická Laboratoř, s.r.o., Pilsen, Czech Republic
| | | | - Jana Němcová
- Department of Pathology, Medical Faculty, Charles University and Charles University Hospital Pilsen, Pilsen, Czech Republic.,Bioptická Laboratoř, s.r.o., Pilsen, Czech Republic
| | | | - Jan Chytra
- Department of Gynecology and Obstetrics, Medical Faculty, Charles University and Charles University Hospital Pilsen, Pilsen, Czech Republic
| | - Jiří Bouda
- Department of Gynecology and Obstetrics, Medical Faculty, Charles University and Charles University Hospital Pilsen, Pilsen, Czech Republic
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Abreu R, Miguel R, Saieg M. Subacute (De Quervain) thyroiditis during the COVID-19 pandemic. Cancer Cytopathol 2021; 129:844-846. [PMID: 33970557 PMCID: PMC8239629 DOI: 10.1002/cncy.22449] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/27/2021] [Accepted: 04/16/2021] [Indexed: 01/08/2023]
Abstract
Coronavirus disease 2019 (COVID‐19) is a new disease whose clinical presentation and potential complications are not yet fully understood. One of these possible reported complications is the onset of subacute (De Quervain) thyroiditis (SAT). Here a series of cases of SAT during the COVID‐19 pandemic are reported, and a possible correlation between these 2 entities is extrapolated.
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Affiliation(s)
- Rodrigo Abreu
- Department of Pathology, A. C. Camargo Cancer Center, Sao Paulo, Brazil
| | | | - Mauro Saieg
- Department of Pathology, A. C. Camargo Cancer Center, Sao Paulo, Brazil.,Fleury Diagnostic Medical Center, Sao Paulo, Brazil.,Department of Pathology, Santa Casa Medical School, Sao Paulo, Brazil
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35
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Cytopathology Practice in the COVID-19 Era: Focus on Sample Workload. JOURNAL OF MOLECULAR PATHOLOGY 2021. [DOI: 10.3390/jmp2020011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Since the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak was declared a pandemic, the magnitude of coronavirus disease 2019 (COVID-19) has continued to grow, putting an unprecedented strain on all medical fields. Its effects on cytopathology workloads have been dramatic. Indeed, despite the implementation of several laboratory biosafety recommendations, cytological screening activities and cytological sampling of patients at low risk of malignancy have been postponed to limit the risk of contagion and to lessen the strain on overwhelmed hospital facilities. In this scenario, a drastic reduction in the total number of cytological specimens has been observed worldwide. This review summarizes the current evidence of the impact of the COVID-19 pandemic on cytopathology practice by focusing on its impact on cytological sample workload.
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36
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Schmitt F. The impact of the COVID-19 pandemic on cytopathology practice. Cytopathology 2021; 32:297-298. [PMID: 33844383 DOI: 10.1111/cyt.12969] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/13/2021] [Accepted: 02/14/2021] [Indexed: 12/15/2022]
Affiliation(s)
- Fernando Schmitt
- Medical Faculty of Porto University, Porto, Portugal.,IPATIMUP (Institute of Molecular Pathology and Immunology of Porto University), Porto, Portugal.,CINTESIS@RISE, Porto, Portugal
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37
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Vigliar E, Cepurnaite R, Iaccarino A, Pisapia P, De Luca C, Malapelle U, Bellevicine C, Troncone G. Cytopathology practice during the COVID-19 postlockdown: An Italian experience. Cancer Cytopathol 2021; 129:548-554. [PMID: 33595924 PMCID: PMC8013362 DOI: 10.1002/cncy.22416] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/18/2021] [Accepted: 01/25/2021] [Indexed: 12/22/2022]
Abstract
Background During the current coronavirus disease 2019 (COVID‐19) pandemic, the cytopathology workload has decreased remarkably worldwide as all screening and elective procedures have been postponed to prioritize the clinical management of patients at high oncological risk. In the current study, the authors provide data on the lasting impact of COVID‐19 on cytopathology practice during the initial phases of the Italian postlockdown period. Methods The percentages of the cytological sample types processed at the University of Naples Federico II during the first 12 weeks of the Italian postlockdown period were compared with those of the same period in 2019. The study period was divided into four 3‐week periods. Differences in the rates of malignant diagnoses were also assessed. Results During the 12‐week study period, the overall cytological sample workload decreased by 41.6% in comparison with 2019. In particular, the workload significantly declined for each sample type: Pap smears, –33.3%; urine, –42.8%; serous fluids, –14.4%; thyroid, –54.5%; breast, –43%; lymph node, –27.3%; and salivary gland, –61%. By contrast, the overall malignancy rate was significantly increased (P = .0011). Conclusions The reduction in the cytological sample workload during the postlockdown period still represents an ongoing effect of the COVID‐19 pandemic. On the other hand, the rise in the overall malignancy rate reflects the importance of prioritizing diagnostic procedures for patients at high oncological risk. The reduction in the cytological sample workload during the postlockdown period represents an ongoing effect of the COVID‐19 pandemic. On the other hand, the rise in the overall malignancy rate reflects the importance of prioritizing diagnostic procedures for patients at high oncological risk.
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Affiliation(s)
- Elena Vigliar
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Rima Cepurnaite
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Antonino Iaccarino
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Pasquale Pisapia
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Caterina De Luca
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Umberto Malapelle
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Claudio Bellevicine
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Giancarlo Troncone
- Department of Public Health, University of Naples Federico II, Naples, Italy
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38
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Hofman P, Copin MC, Tauziede-Espariat A, Adle-Biassette H, Fortarezza F, Passeron T, Salmon I, Calabrese F. [Histopathological features due to the SARS-CoV-2]. Ann Pathol 2021; 41:9-22. [PMID: 33446414 PMCID: PMC7773006 DOI: 10.1016/j.annpat.2020.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/23/2020] [Accepted: 12/28/2020] [Indexed: 02/06/2023]
Abstract
The infection due to the SARS-CoV-2 leads lesions mainly observed at the respiratory tract level, but not exclusively. The analyses of these lesions benefited from different autopsy studies. Thus, these lesions were observed in different organs, tissues and cells. These observations allowed us to rapidly improve the knowledge of the pathophysiological mechanisms associated with this emergent infectious disease. The virus can be detected in formalin fixed paraffin embedded tissues using immunohistochemistry, in situ hybridization, molecular biology and/or electron microscopy approaches. However, many uncertainties are still present concerning the direct role of the SARS-CoV-2 on the different lesions observed in different organs, outside the lung, such as the heart, the brain, the liver, the gastrointestinal tract, the kidney and the skin. In this context, it is pivotal to keep going to increase the different tissue and cellular studies in the COVID-19 positive patients aiming to better understanding the consequences of this new infectious disease, notably considering different epidemiological and co-morbidities associated factors. This could participate to the development of new therapeutic strategies too. The purpose of this review is to describe the main histological and cellular lesions associated with the infection due to the SARS-CoV-2.
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Affiliation(s)
- Paul Hofman
- Laboratoire de pathologie clinique et expérimentale, hôpital Pasteur, centre hospitalo-universitaire de Nice, université Côte d'Azur, B.P. 69-30, avenue de la voie romaine, 06001 Nice cedex 01, France; Biobanque hospitalière (BB-0033-00025), hôpital Pasteur, Nice, France; FHU OncoAge, hôpital Pasteur, Nice, France.
| | - Marie-Christine Copin
- Université d'Angers, Inserm, CRCINA, Angers, France; Département de pathologie, centre hospitalo-universitaire, Angers, France
| | - Arnault Tauziede-Espariat
- Service de neuropathologie, GHU de Paris psychiatrie et neurosciences, hôpital Saint-Anne, Paris, France
| | | | - Francesco Fortarezza
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova Medical School, Padova, Italie
| | - Thierry Passeron
- Département de dermatologie, hôpital Archet II, centre hospitalo-universitaire de nice, université Côte d'Azur, Nice, France
| | - Isabelle Salmon
- Département de pathologie, hôpital Erasme, université Libre de Bruxelles, Bruxelles, Belgique
| | - Fiorella Calabrese
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova Medical School, Padova, Italie
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39
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[Management of samples in pathology laboratories and biobanks during the Covid-19 pandemic]. ACTA ACUST UNITED AC 2021; 2021:36-42. [PMID: 33437317 PMCID: PMC7789903 DOI: 10.1016/s1773-035x(20)30392-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
La pandémie liée à la Covid-19 a brutalement bouleversé le fonctionnement des hôpitaux, en particulier les activités des services cliniques et des laboratoires de biologie, notamment de virologie. Cette pandémie a eu aussi une répercussion soudaine sur la prise en charge des échantillons tissulaires et cellulaires par les laboratoires de pathologie. Les conséquences ont été l’optimisation de mesures sanitaires au sein de ces laboratoires, mais aussi selon les institutions, une forte diminution dans différents secteurs d’activité de la pathologie clinique et moléculaire. Ainsi, les pathologistes ont dû s’adapter très rapidement à de nouvelles contraintes sanitaires, et organiser les laboratoires selon des recommandations internationales, afin de maintenir l’offre de soins aux patients hospitalisés, en particulier ceux atteints d’un cancer. Cette revue aborde les principales conséquences de la pandémie liée à la Covid-19 au niveau des laboratoires de pathologie et les mesures prises par ces laboratoires pour assurer leur fonctionnement durant cette période.
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40
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Ardon O, Reuter VE, Hameed M, Corsale L, Manzo A, Sirintrapun SJ, Ntiamoah P, Stamelos E, Schueffler PJ, England C, Klimstra DS, Hanna MG. Digital Pathology Operations at an NYC Tertiary Cancer Center During the First 4 Months of COVID-19 Pandemic Response. Acad Pathol 2021; 8:23742895211010276. [PMID: 35155745 PMCID: PMC8819741 DOI: 10.1177/23742895211010276] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/18/2021] [Accepted: 03/21/2021] [Indexed: 11/21/2022] Open
Abstract
Implementation of an infrastructure to support digital pathology began in 2006 at
Memorial Sloan Kettering Cancer Center. The public health emergency and COVID-19
pandemic regulations in New York City required a novel workflow to sustain
existing operations. While regulatory enforcement discretions offered faculty
workspace flexibility, a substantial portion of laboratory and digital pathology
workflows require on-site presence of staff. Maintaining social distancing and
offering staggered work schedules. Due to a decrease in patients seeking health
care at the onset of the pandemic, a temporary decrease in patient specimens was
observed. Hospital and travel regulations impacted onsite vendor technical
support. Digital glass slide scanning activities onsite proceeded without
interruption throughout the pandemic, with challenges including staff who
required quarantine due to virus exposure, unrelated illness, family support, or
lack of public transportation. During the public health emergency, we validated
digital pathology systems for a remote pathology operation. Since March 2020,
the departmental digital pathology staff were able to maintain scanning volumes
of over 100 000 slides per month. The digital scanning team reprioritized
archival slide scanning and participated in a remote sign-out validation and
successful submission of New York State approval for a laboratory developed
test. Digital pathology offers a health care delivery model where pathologists
can perform their sign out duties at remote location and prevent disruptions to
critical pathology services for patients seeking care at our institution during
emergencies. Development of standard operating procedures to support digital
workflows will maintain turnaround times and enable clinical operations during
emergency or otherwise unanticipated events.
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Affiliation(s)
- Orly Ardon
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Victor E Reuter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,The Warren Alpert Center for Digital and Computational Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Meera Hameed
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,The Warren Alpert Center for Digital and Computational Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lorraine Corsale
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Allyne Manzo
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sahussapont J Sirintrapun
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,The Warren Alpert Center for Digital and Computational Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peter Ntiamoah
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Evangelos Stamelos
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peter J Schueffler
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,The Warren Alpert Center for Digital and Computational Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christine England
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David S Klimstra
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,The Warren Alpert Center for Digital and Computational Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Matthew G Hanna
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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41
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Faquin WC. The state of cytopathology laboratories during the COVID-19 pandemic. Cancer Cytopathol 2020; 128:881-882. [PMID: 33264514 PMCID: PMC7753774 DOI: 10.1002/cncy.22393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/09/2020] [Indexed: 01/14/2023]
Abstract
The coronavirus disease 2019 (COVID‐19) pandemic continues to wreak havoc around the world, with a current total of 50.1 million cases of COVID‐19 worldwide and greater than 1.25 million deaths related to the disease. Hospitals have struggled to respond to the needs of their communities, with the pandemic's impact being felt in nearly all areas, including cytopathology laboratories. This issue of Cancer Cytopathology includes several original articles, commentaries, and correspondence describing a wide range of topics related to the effects of the COVID‐19 pandemic on the field of cytopathology.
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Affiliation(s)
- William C Faquin
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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42
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Iaccarino A, Pisapia P, Vigliar E, Vielh P, Troncone G. Juggling the COVID-19 pandemic: A cytopathology point of view. Cytopathology 2020; 32:299-303. [PMID: 33145830 DOI: 10.1111/cyt.12936] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/21/2020] [Accepted: 11/02/2020] [Indexed: 12/13/2022]
Abstract
Since its first identification in China at the end of 2019, severe acute respiratory syndrome coronavirus 2 has rapidly spread all over the world, becoming an international healthcare emergency. In the era of coronavirus disease-2019 (COVID-19), several aspects of normal life, including those related to the medical activities, have been radically changed. Extraordinary measures have been adopted by different nations to cope with the rapid diffusion of COVID-19 all over the world. In hospitals, careful attention has been paid to manage infected patients with a possible detrimental effect for patients affected by other diseases. As with other medical fields, cytopathology laboratories have also drastically modified their activities to cope with the COVID-19 healthcare emergency. Here, the main effects of COVID-19 pandemic on the routine practice of cytopathology are summarised, focusing on the prioritisation policy adopted by cytopathologists worldwide.
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Affiliation(s)
- Antonino Iaccarino
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Pasquale Pisapia
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Elena Vigliar
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | | | - Giancarlo Troncone
- Department of Public Health, University of Naples Federico II, Naples, Italy
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43
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Hofman P, Ilié M, Chamorey E, Brest P, Schiappa R, Nakache V, Antoine M, Barberis M, Begueret H, Bibeau F, Bonnetaud C, Boström P, Brousset P, Bubendorf L, Carvalho L, Cathomas G, Cazes A, Chalabreysse L, Chenard MP, Copin MC, Côté JF, Damotte D, de Leval L, Delongova P, Thomas de Montpreville V, de Muret A, Dema A, Dietmaier W, Evert M, Fabre A, Forest F, Foulet A, Garcia S, Garcia-Martos M, Gibault L, Gorkiewicz G, Jonigk D, Gosney J, Hofman A, Kern I, Kerr K, Kossai M, Kriegsmann M, Lassalle S, Long-Mira E, Lupo A, Mamilos A, Matěj R, Meilleroux J, Ortiz-Villalón C, Panico L, Panizo A, Papotti M, Pauwels P, Pelosi G, Penault-Llorca F, Pop O, Poté N, Cajal SRY, Sabourin JC, Salmon I, Sajin M, Savic-Prince S, Schildhaus HU, Schirmacher P, Serre I, Shaw E, Sizaret D, Stenzinger A, Stojsic J, Thunnissen E, Timens W, Troncone G, Werlein C, Wolff H, Berthet JP, Benzaquen J, Marquette CH, Hofman V, Calabrese F. Clinical and molecular practice of European thoracic pathology laboratories during the COVID-19 pandemic. The past and the near future. ESMO Open 2020; 6:100024. [PMID: 33399086 PMCID: PMC7780004 DOI: 10.1016/j.esmoop.2020.100024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/19/2020] [Accepted: 11/21/2020] [Indexed: 12/18/2022] Open
Abstract
Background This study evaluated the consequences in Europe of the COVID-19 outbreak on pathology laboratories orientated toward the diagnosis of thoracic diseases. Materials and methods A survey was sent to 71 pathology laboratories from 21 European countries. The questionnaire requested information concerning the organization of biosafety, the clinical and molecular pathology, the biobanking, the workload, the associated research into COVID-19, and the organization of education and training during the COVID-19 crisis, from 15 March to 31 May 2020, compared with the same period in 2019. Results Questionnaires were returned from 53/71 (75%) laboratories from 18 European countries. The biosafety procedures were heterogeneous. The workload in clinical and molecular pathology decreased dramatically by 31% (range, 3%-55%) and 26% (range, 7%-62%), respectively. According to the professional category, between 28% and 41% of the staff members were not present in the laboratories but did teleworking. A total of 70% of the laboratories developed virtual meetings for the training of residents and junior pathologists. During the period of study, none of the staff members with confirmed COVID-19 became infected as a result of handling samples. Conclusions The COVID-19 pandemic has had a strong impact on most of the European pathology laboratories included in this study. Urgent implementation of several changes to the organization of most of these laboratories, notably to better harmonize biosafety procedures, was noted at the onset of the pandemic and maintained in the event of a new wave of infection occurring in Europe. Biosafety measures used in the first wave of the COVID-19 crisis were heterogeneous in 53 European pathology laboratories. A dramatic decrease of the workload in pathology laboratories was noted. No case of healthcare workers contaminated with SARS-CoV-2 associated with samples handling was identified.
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Affiliation(s)
- P Hofman
- Laboratory of Clinical and Experimental Pathology, FHU OncoAge, BB-0033-00025, Louis Pasteur Hospital, IRCAN, Université Côte d'Azur, Nice, France.
| | - M Ilié
- Laboratory of Clinical and Experimental Pathology, FHU OncoAge, BB-0033-00025, Louis Pasteur Hospital, IRCAN, Université Côte d'Azur, Nice, France
| | - E Chamorey
- Epidemiology and Biostatistics Unit, Centre Antoine-Lacassagne, Université Côte d'Azur, Nice, France
| | - P Brest
- Team 4, IRCAN, INSERM, CNRS, Centre Antoine-Lacassagne, Université Côte d'Azur, Nice, France
| | - R Schiappa
- Epidemiology and Biostatistics Unit, Centre Antoine-Lacassagne, Université Côte d'Azur, Nice, France
| | - V Nakache
- Laboratory of Clinical and Experimental Pathology, FHU OncoAge, BB-0033-00025, Louis Pasteur Hospital, IRCAN, Université Côte d'Azur, Nice, France
| | - M Antoine
- Department of Pathology, Hôpital Tenon, AP-HP, Paris, France
| | - M Barberis
- Unit of Histopathology and Molecular Diagnostics, Division of Pathology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - H Begueret
- Department of Pathology, University Hospital of Bordeaux, Bordeaux, France
| | - F Bibeau
- Department of Pathology, CHU de Caen, Université de Caen Normandie, Caen, France
| | - C Bonnetaud
- Laboratory of Clinical and Experimental Pathology, FHU OncoAge, BB-0033-00025, Louis Pasteur Hospital, IRCAN, Université Côte d'Azur, Nice, France
| | - P Boström
- Department of Pathology, Turku University Hospital, Turku, Finland
| | - P Brousset
- Department of Pathology, IUC-T-Oncopole, Inserm U1037 CRCT, Université de Toulouse, Toulouse, France
| | - L Bubendorf
- Institute of Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - L Carvalho
- Institute of Anatomical and Molecular Pathology and University Hospital, University of Coimbra, Coimbra, Portugal
| | - G Cathomas
- Institute of Pathology, Cantonal Hospital Baselland, Liestal, Switzerland
| | - A Cazes
- Department of Pathology, Bichat Hospital, AP-HP, Inserm UMR 1152, Université de Paris, Paris, France
| | - L Chalabreysse
- Department of Pathology, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France
| | - M-P Chenard
- Department of Pathology, University Hospital of Strasbourg, Strasbourg, France
| | - M-C Copin
- Institut de Pathologie, CHU Lille, Université de Lille, Lille, France
| | - J-F Côté
- Department of Pathology, Institut Mutualiste Montsouris, Paris, France
| | - D Damotte
- Department of Pathology, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Inserm U1138, Université de Paris, Paris, France
| | - L de Leval
- Institute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - P Delongova
- Institute of Pathology, University Hospital Ostrava, Ostrava, Czech Republic
| | | | - A de Muret
- Department of Pathology, University Hospital of Tours, Tours, France
| | - A Dema
- Department of Pathology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - W Dietmaier
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - M Evert
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - A Fabre
- Department of Histopathology, St Vincent's University Hospital, University College Dublin School of Medicine, Dublin, Ireland
| | - F Forest
- Department of Pathology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - A Foulet
- Department of Pathology, Centre Hospitalier, Le Mans, France
| | - S Garcia
- Department of Pathology, Hôpital Nord, AP-HM, Aix Marseille University, Marseille, France
| | - M Garcia-Martos
- Pulmonary Pathology Department, Gregorio Marañon University Hospital, Madrid, Spain
| | - L Gibault
- Department of Pathology, Hôpital Européen Georges Pompidou, AP-HP, Université de Paris, Paris, France
| | - G Gorkiewicz
- Institute of Pathology, Medical University of Graz, Graz, Austria
| | - D Jonigk
- Institute of Pathology, German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Disease Hannover, Hannover Medical School, Hannover, Germany
| | - J Gosney
- Liverpool University Hospitals, Royal Liverpool University Hospital, Liverpool, UK
| | - A Hofman
- Laboratory of Clinical and Experimental Pathology, FHU OncoAge, BB-0033-00025, Louis Pasteur Hospital, IRCAN, Université Côte d'Azur, Nice, France
| | - I Kern
- Department of Pathology, University Clinic Golnik, Golnik, Slovenia
| | - K Kerr
- Department of Pathology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - M Kossai
- Department of Pathology and Molecular Pathology, Centre Jean Perrin, Clermont-Ferrand, France
| | - M Kriegsmann
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, and German Center for Lung Research (DZL), Germany
| | - S Lassalle
- Laboratory of Clinical and Experimental Pathology, FHU OncoAge, BB-0033-00025, Louis Pasteur Hospital, IRCAN, Université Côte d'Azur, Nice, France
| | - E Long-Mira
- Laboratory of Clinical and Experimental Pathology, FHU OncoAge, BB-0033-00025, Louis Pasteur Hospital, IRCAN, Université Côte d'Azur, Nice, France
| | - A Lupo
- Department of Pathology, Hôpitaux Universitaires Paris Centre, Hôpital Cochin, Inserm U1138, Université de Paris, Paris, France
| | - A Mamilos
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - R Matěj
- Department of Pathology and Molecular Medicine, Third Faculty of Medicine, Charles University, Thomayer Hospital and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - J Meilleroux
- Department of Pathology, IUC-T-Oncopole, Inserm U1037 CRCT, Université de Toulouse, Toulouse, France
| | - C Ortiz-Villalón
- Department of Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - L Panico
- Unit of Pathology, Azienda Ospedaliera dei Colli, Monaldi-Cotugno-CTO, Naples, Italy
| | - A Panizo
- Department of Pathology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - M Papotti
- Department of Oncology, University of Torino, Torino, Italy
| | - P Pauwels
- Centre for Oncological Research (CORE), University of Antwerp, Antwerp, Belgium
| | - G Pelosi
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, and IRCCS MultiMedica, Milan, Italy
| | - F Penault-Llorca
- Department of Pathology and Molecular Pathology, Centre Jean Perrin, Clermont-Ferrand, France
| | - O Pop
- Department of Pathology, University of Oradea, Oradea, Romania
| | - N Poté
- Department of Pathology, Bichat Hospital, AP-HP, Inserm UMR 1152, Université de Paris, Paris, France
| | - S R Y Cajal
- Department of Pathology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - J-C Sabourin
- Department of Pathology, Inserm 1245, Rouen University Hospital Normandy University, Rouen, France
| | - I Salmon
- Department of Pathology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - M Sajin
- Department of Pathology, Emergency University Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - S Savic-Prince
- Institute of Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - H-U Schildhaus
- Institute of Pathology, University Hospital Essen, Essen, Germany
| | - P Schirmacher
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, and German Center for Lung Research (DZL), Germany
| | - I Serre
- Department of Biopathology, Gui de Chauliac Hospital, Montpellier University Hospital, Montpellier, France
| | - E Shaw
- Department of Cellular Pathology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - D Sizaret
- Department of Pathology, University Hospital of Tours, Tours, France
| | - A Stenzinger
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, and German Center for Lung Research (DZL), Germany
| | - J Stojsic
- Department of Thoracic Pathology, Service of Pathology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - E Thunnissen
- Department of Pathology, Amsterdam University Medical Centres, Location VUmc, Amsterdam, The Netherlands
| | - W Timens
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - G Troncone
- Department of Public Health, University of Naples Frederico II, Naples, Italy
| | - C Werlein
- Institute of Pathology, German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Disease Hannover, Hannover Medical School, Hannover, Germany
| | - H Wolff
- Laboratory of Pathology, Finnish Institute of Occupational Health, Helsinki, Finland
| | - J-P Berthet
- Department of Thoracic Surgery, FHU OnoAge, Louis Pasteur Hospital, University Côte d'Azur, Nice, France
| | - J Benzaquen
- Department of Pneumology, FHU OncoAge, Louis Pasteur Hospital, IRCAN, Université Côte d'Azur, Nice, France
| | - C-H Marquette
- Department of Pneumology, FHU OncoAge, Louis Pasteur Hospital, IRCAN, Université Côte d'Azur, Nice, France
| | - V Hofman
- Laboratory of Clinical and Experimental Pathology, FHU OncoAge, BB-0033-00025, Louis Pasteur Hospital, IRCAN, Université Côte d'Azur, Nice, France
| | - F Calabrese
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Pathological Anatomy Section, University of Padova Medical School, Padova, Italy
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