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      The Two Sides of Cytopathology during the COVID-19 Health Emergency: Screening versus Diagnosis

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      S. Karger AG

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          The current pandemic caused by severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) has highlighted the fact that cytology plays not only a screening but also a full diagnostic role [1, 2, 3]. Undoubtedly, the aggressive containment measures implemented at the beginning of the outbreak by nearly all European governments were meant to prevent the fast spread of the virus and to flatten the curve of infection, which indeed they did. On the other hand, they led to a drastic reduction, if not interruption, in the volume of health care procedures, in particular cancer screening programs, as de Pelsemaeker et al. [4] consistently detail in this journal. These authors adopted the global histopathological and cytological workload as the main health care system activity indicator. Their findings indicate that the histological activities reflect not only different types of biopsies (mainly endoscopic, cervical, skin, bone marrow, breast, and prostate) but also different types of surgical specimens (specifically breast, thyroid, and lower digestive tract). Although their data shows a significant reduction in the total histological workload during the emergency, more complex and critical cases continue to be received and processed. Consistently, in a recent study [5], we reported that during the emergency, the percentage of malignant cytology samples increased, as evidenced by higher percentages of breast and lymph node fine needle aspiration specimens, effusions, and urine samples. The role of cytopathology is however de-emphasized by de Pelsemaeker et al. [4]. A possible explanation is that their cytological workload analyzes only cervical smears, which are reduced up to 80%, and pulmonary biopsies by endobronchial ultrasound, which are reduced up to 82%. This latter result might be due to the so-called “distraction effect” which led pneumologists, like other specialists, to divert their attention almost exclusively toward fighting SARS-CoV-2. The assessment of de Pelsemaeker et al. does not embrace other fields of diagnostic cytopathology, apart from those mentioned. Therefore, their work creates a skewed perception of the actual contribution of cytopathology to diagnosis and disease management, thereby relegating its role to that of a mere screening tool, which can be interrupted and postponed until the end of the emergency without detrimental consequences for patients. Therefore, a multi-institutional effort involving cytopathology laboratories worldwide is warranted to reinforce the impression of cytology not only as a screening tool but also as an autonomous, fully-fledged diagnostic procedure even during the COVID-19 pandemic. Conflict of Interest Statement The authors declare no potential conflicts of interest. Funding Sources The authors have not declared a specific grant for this paper from any funding agency in the public, commercial, or not-for-profit sectors.

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          Most cited references 5

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          The COVID-19 pandemic: Implications for the cytology laboratory

          The coronavirus disease 2019 (COVID-19) is a pandemic with the SARS-CoV-2 virus. The infection has predominantly respiratory transmission and is transmitted through large droplets or aerosols, and less commonly by contact with infected surfaces or fomites. The alarming spread of the infection and the severe clinical disease that it may cause, have led to the widespread institution of social distancing measures. Due to repeated exposure to potentially infectious patients and specimens, healthcare and laboratory personnel are particularly susceptible to contract COVID-19. This review paper provides an assessment of the current state of knowledge about the disease and its pathology, and the potential presence of the virus in cytology specimens. It also discusses the measures that cytology laboratories can take to function during the pandemic, and minimize the risk to their personnel, trainees and pathologists. In addition, it explores potential means to continue to educate trainees during the COVID-19 pandemic.
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            Cytology in the time of coronavirus disease (covid-19): an Italian perspective

            Introduction The coronavirus disease 2019 (covid-19) is changing the way we practice pathology, including fine needle aspiration (FNA) diagnostics. Although recommendations have been issued to prioritise patients at high oncological risk, postponing those with unsuspicious presentations, real world data have not been reported yet. Methods The percentages of the cytological sample types processed at the University of Naples Federico II, during the first 3 weeks of Italian national lockdown were compared with those of the same period in 2019. Results During the emergency, the percentage of cytology samples reported as malignant increased (p<0.001), reflecting higher percentages of breast (p=0.002) and lymph nodes FNAs (p=0.008), effusions (p<0.001) and urine (p=0.005). Conversely, thyroid FNAs (p<0.001) and Pap smears (p=0.003) were reduced. Conclusions Even in times of covid-19 outbreak, cytological examination may be safely carried out in patients at high oncological risk, without the need to be postponed.
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              Pathologists and the coronavirus distraction effect


                Author and article information

                S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, )
                21 July 2020
                : 1-2
                Department of Public Health, University of Naples Federico II, Naples, Italy
                Author notes
                *Giancarlo Troncone, Department of Public Health, University of Naples Federico II, Via Sergio Pansini 5, IT–80131 Naples (Italy), giancarlo.troncone@
                Copyright © 2020 by S. Karger AG, Basel

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

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                References: 5, Pages: 2


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