The role of breast fine needle aspiration during and post-COVID-19 pandemic: A fast and safe alternative to needle core biopsy

CT Scan-Guided Fine Needle Aspiration Cytology for Lung Cancer Diagnosis through the COVID-19 Pandemic: What We Have Learned

Background and rationale. Novel coronavirus-related disease (COVID-19) has profoundly influenced hospital organization and structures worldwide. In Italy, the Lombardy Region, with almost 17% of the Italian population, rapidly became the most severely affected area since the pandemic beginning. The first and the following COVID-19 surges significantly affected lung cancer diagnosis and subsequent management. Much data have been already published regarding the therapeutic repercussions whereas very few reports have focused on the consequences of the pandemic on diagnostic procedures. Methods. We, here, would like to analyze data of novel lung cancer diagnosis performed in our Institution in Norther Italy where we faced the earliest and largest outbreaks of COVID-19 in Italy. Results. We discuss, in detail, the strategies developed to perform biopsies and the safe pathways created in emergency settings to protect lung cancer patients in subsequent therapeutic phases. Quite unexpectedly, no significant differences emerged between cases enrolled during the pandemic and those before, and the two populations were homogeneous considering the composition and diagnostic and complication rates. Conclusions. By pointing out the role of multidisciplinarity in emergency contexts, these data will be of help in the future for designing tailored strategies to manage lung cancer in a real-life setting.

Performance of breast fine needle aspiration as an initial diagnostic tool: A large academic hospital experience

BACKGROUND

The clinical performance of the Yokohama reporting system for breast cytology remains uncertain.

METHODS

In this study, we retrospectively evaluated 318 breast fine needle aspirations (FNABs) from Los Angeles County Hospital over a five-year period, analysing data for breast cytology, histology, and radiology.

RESULTS

Among 318 breast FNAB cases, 78.3% (249/318) were benign and 5.3% (17/318) malignant. Of 83 cases with follow-up histology, 14.5% (12/83) were insufficient, 66.3% (55/83) were benign, and 16.9% (17/83) were malignant. Of 55 benign cases, 61.8% (34/55) were fibroadenoma and 9 (9/55, 16.4%) were fibrocystic changes. Two cases were diagnosed as "atypical" but confirmed "benign" on core needle biopsy (CNB). No "suspicious" cases were found. Seventeen malignant cases were confirmed by CNB, including 70.6% (12/17) invasive ductal carcinoma, 11.8% (2/17) invasive lobular carcinoma, and one malignant phyllodes tumour. Receptor studies on cell blocks of three malignant cases showed concordant results with CNB results. In addition, 82.2% (148/180) of lesions with Breast Imaging-Reporting and Data System (BI-RADS) scores of 2 or 3 were benign and 92.3% (12/13) BI-RADS score 5 lesions were malignant on FNAB. Finally, 90% (67/74) of BI-RADS 4a lesions were benign, and 97% (36/37) of fibroadenomas were BI-RADS score 4a.

CONCLUSION

This, by far the largest U.S. breast cytology study, showed 93.3% sensitivity, 100% specificity, 100% positive predictive value, and 98.2% negative predictive value for breast FNAB. Women with breast lesions of BI-RADS score 3 or less have a low risk of malignancy; FNAB would contribute to the reduction of excisional biopsies. FNAB can be considered as an initial diagnostic tool for BI-RADS 4 mass/lesions and satellite lesions, as well as for triaging patients.

COVID-19 pandemisinin meme kanser teşhis sürecine etkisi

Purpose: The primary aim of thşis study was to evaluate difference in the number of patients with tru-cut biopsies to diagnose breast lesions between non-pandemic and pandemic periods. Materials and Methods: In this study, the nonpandemic period and the pandemic period were compared, the periods for the pandemic times, between March 1, 2018, and 29 February 2020, and for the nonpandemic period, 1 March 2020 to 12 March 2022 to 12 March 2022. In each period, we have included all the tru-cut biopsies for suspected breast cancer. During the pandemic and non-pandemic period, the number of tru-cut biopsies BI-RADS and histopathological findings of the patients who experienced tru-cut biopsies were compared. Results: The number of tru-cut biopsies performed during the nonpandemic and pandemic period was similar (1596, 1599). In the pandemic period, tru-cut biopsy histopathologic reports revealed that benign and high-risk cases decreased statistically, while invasive carcinoma cases increased by 1.9 (95% CI 1.6-2.2) times. During the pandemic period, US-guided BI-RADS 3 and BI-RADS 4a cases decreased statistically significantly, BBI-RADS 4b cases increased 1.4 (95% CI 1.1-2.2) times, BI-RADS 4c cases 1.7 (95% CI 1.2-2.2), BI-RADS 5 cases increased 2.1 (95% CI 1.4-3.1) times Conclusion: There was no significant change in tru-cut biopsy numbers compared to the period of the pandemic and the non-pandemic period. However, the stage of the cancers captured during the period of the pandemic was higher.

Cytopathology practice during the COVID-19 postlockdown: An Italian experience

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.

Juggling the COVID-19 pandemic: A cytopathology point of view

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.