Early detection of recurrent HPV+ hypopharyngeal squamous cell carcinoma by circulating tumor DNA

Circulating tumor DNA is a liquid biomarker that offers a highly specific method to assess HPV-associated tumor burden via a blood draw. It has the potential for many clinical applications in cancer care, including prognostication, monitoring treatment response, and surveillance for disease recurrence. In this case report, we present a case of recurrent HPV-associated hypopharyngeal squamous cell carcinoma first detected by circulating tumor HPV DNA that demonstrates the role of circulating tumor HPV DNA tests in posttreatment surveillance and the utility of HPV testing in all HPV-mediated tumors, regardless of subsite.Copyright © 2023 Elsevier Inc.

Clinical and Cytopathological Traits of Herpes Zoster: A Report of Two Cases

Introduction: Varicella zoster virus is a highly infectious alpha-herpesvirus, pathogenic only to humans. The primary infection of varicella zoster virus causes chickenpox, which is contagious and primarily infects children and adolescents in India. Following the primary infection, the virus remains dormant in sensory root ganglia. Activation of the dormant virus in later stages of life causes herpes zoster infection which may vary from subclinical infection to typical zoster, scattered vesicles, zoster sine herpete or disseminated zoster, which depends on the individual's immune status. Case report: In this case series, we present two patients with herpes zoster involving the mandibular branch of the trigeminal nerve. Cytology revealed characteristic features of the infection including nuclear moulding, multinucleated giant cells and ballooning degeneration. Conclusion(s): More recently, patients presenting with herpes zoster have been reported to have sub-clinical Covid-19 infection, suggesting a possibility that herpes zoster might be an indicator for latent Covid-19. Timely detection and treatment of this infection can reduce the risk of post herpetic neuralgia.Copyright © 2022 Sciendo. All rights reserved.

Science, Medicine, and Cytology: A Pilot Program of the ASC Diversity Equity and Inclusion (DEI) Committee

Introduction: The percentage of pathology trainees who are underrepresented minorities is low. The DEI committee established a Science, Medicine, and Cytology summer pilot program to improve exposure to cytopathology focusing on DEI. Material(s) and Method(s): An online course was developed during the Covid-19 pandemic targeting underrepresented minorities at the high school and college level, and consisted of several didactic sessions, presenting the most common procedures involving cytologists, including fine-needle aspiration, rapid onsite evaluation, and smearing techniques. Interviews of cytopathologists were also included. Participants were surveyed for their demographic information and for an evaluation of the course. Result(s): 23 participants completed the survey (Table 1). The highest level of education was high school 16 (70%), college 6 (26%), and other 1 (4%). Self-identified demographics included 2 (9%) Hispanic, 9 (36%) Asian/Asian American, 2 (8%) Black / Black American, 6 (24%) White/Caucasian, 2 (8%) African, 1 (4%) Muslim American and 1 (4%) Sudanese. Household highest level of education was high school 2 (9%), some college 1 (4%), completed college 9 (39%), completed graduate program 9 (39%), 2 (9%) preferred not to answer. 14 (61%) participants have a family member in healthcare. The program met expectations for 20 (87%). The program format was effective and appropriate for their level of education for 23 (100%). The content helpful for 22 (96%). 13 (57%) considered healthcare as a potential career. 5 (22%) considered cytology as a career (Table 2). Conclusion(s): Evaluations were excellent, generating awareness of medicine and cytopathology. Individuals with families in healthcare were overrepresented, as there were barriers in reaching underrepresented minorities. The population that signed up was influenced by our ability offer the course online. Expansion to a wider audience would increase the number of attendees. (Table Presented).

Implications of Corona Virus Disease-19 Pandemic on Cytopathology Laboratory-Challenges and Solutions in Resource Limited Setting

Introduction: Corona Virus Disease-19 (COVID-19) disease which is still showing peaks and plateau with emerging new mutational variants led to modification of working of hospitals and medical institutes. The present study was conducted to study various measures adopted and changes made in the cytopathology laboratory during COVID-19 infection in resource limited setting but catering to large population of covid patients. It was also intended to study methods adopted for effective cytopathology residency training during corona times. Material(s) and Method(s): The study analyzed the working of cytopathology lab during corona times from March 2020 till December 2021 and compared it with pre corona times from March 2018 till December 2019. The different methods adopted for effective cytopathology residency training were also analyzed. Result(s): A decrease of 1.9% of cases was observed during corona with increase of 17.4% for samples of respiratory tract including aspergillosis, mucormycosis and tuberculosis (Table1). There was 10.3% increase in cytological diagnosis of malignant cases during corona times (Table 2). Use of 90% alcohol for fixation, avoiding of pneumatic tube, judicious use of PPE kit along with access of digital cytology slides database was included in the changes made in the lab (Table 3). Conclusion(s): There was marginal decrease of cytopathological diagnosis during COVID-19 with substantial increase in malignancy rate of 10.3% in cytological diagnosis of different organs. Diagnosis of mucormycosis, aspergillus and tuberculer infection in respiratory tract cytology increased during this period. Judicious use of limited available resources led not only to smooth functioning of the cytopathology lab but also prevented any infection in the working health personals. Newer online resources were explored and modified for continuous training of the Cytopathology residents. Emotional support with effective communication was the key to alleviate any psychological stress amongst health professionals in the Cytopathology laboratory.

21st International Congress of Cytology with the ASC 70th Annual Scientific Meeting

The proceedings contain 158 papers. The topics discussed include: use of cumulative sum in the assessment of diagnostic competency of cytopathology fellows;what's up in Whatsapp - telecytopathology experience connecting rural districts of Punjab to a tertiary care center in India;ballistic gel model for ultrasound-guided fine needle aspiration: a cost-effective method for simulation training;science, medicine, and cytology: a pilot program of the ASC diversity equity and inclusion (DEI) committee;comparison of low-cost phantoms for ultrasound guided fine needle aspiration biopsy teaching;deep learning algorithm for malignant pleural fluids cytology;application of international system for reporting serous fluid cytology (ISRSFC) in effusion samples - a prospective study;evaluation of 'crowd wisdom' in biliary brush cytology;characterization of the cellular composition of malignant pleural effusion specimens for clinical applications: preliminary study;and diagnostic criteria for COVID-19 pneumonia in broncho-alveolar lavage specimens.

Digital diagnostic cytopathology: Has the pandemic brought us closer?

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.

Abstracts from the 34th International Congress of the International Academy of Pathology

The proceedings contain 329 papers. The topics discussed include: Incidence of methamphetamine use in homicide victims - a retrospective study;the investigation of traumatic brain injury death during COVID-19 pandemic lockdown in Ulaanbaatar, Mongolia;what is the place of YouTube in general pathology learning?;clinical application of pathology in a blended online and in-person curriculum;can knowledge about how to learn pathology effectively influence student academic practice;the impact of the COVID-19 pandemic on fine-needle aspiration practice for cytopathology education;teaching and learning of pathology at undergraduate level: How does it impact postgraduate medical education in various specialities;spectrum of chromosomal abnormalities in acute myeloid leukemia (AML) and acute lymphoid leukemia (ALL);programmed death-ligand 1 expression in diffuse large B-cell lymphoma is associated with poor prognosis;clinicopathological study of plasma cell myeloma in Oman with special reference to its cytogenetic features;and an unusual case of extranodal Rosai-Dorfman disease presenting as a spinal cord compression.

Diagnostic Yield Vs Diagnostic Accuracy for Lung Nodule Biopsy Evaluation: Evidence Supporting a Pragmatic End Point for Future Studies

SESSION TITLE: Lung Nodule Biopsy: Yield and Accuracy SESSION TYPE: Original Investigations PRESENTED ON: 10/16/2022 10:30 am - 11:30 am PURPOSE: A variety of endpoints have been used to evaluate the diagnostic performance of navigational bronchoscopy for sampling peripheral pulmonary lesions (PPLs), including diagnostic yield (rate of biopsies with a specific diagnosis that facilitates clinical decisions) and diagnostic accuracy (yield plus a follow-up to assess for false negative/positive initial results). There is also significant variation in what non-malignant findings are considered diagnostic, especially regarding nonspecific inflammatory changes. We hypothesized a diagnostic yield definition excluding nonspecific findings as diagnostic would lead to few false negative PPL biopsies. METHOD(S): Our center maintains a prospective cohort of consecutive PPLs targeted via navigational bronchoscopy. Diagnostic yield was defined as specific findings readily explaining the presence of a PPL (malignancy, organizing pneumonia, granulomatous inflammation, frank purulence, other specific finding) permitting management without immediate additional diagnostic intervention. "Other specific finding" required pulmonologist and lung pathologist agreement. All other findings were considered non-diagnostic. RESULT(S): A total of 450 PPLs biopsied 2017-2019 with complete two-year follow-up were included in the analysis. Ultimately, 274 of 450 (60.9%) PPLs were determined to be malignant. Diagnostic biopsies were obtained in 331 cases (73.6%). There was a single false-positive among 228 malignant biopsies (0.4%, carcinoid tumor on cytopathology, alveolar adenoma on resection surgical pathology). Among 223 PPLs without malignant diagnosis at initial bronchoscopy, 48 were later determined to be malignant. Most (n=39) exhibited nonspecific abnormalities on initial pathology. Two of 104 specific benign biopsies were false negative (1.9%). Both demonstrated organizing pneumonia on initial pathology but re-biopsy months after index bronchoscopy revealed Hodgkin's lymphoma and metastatic renal cell carcinoma, respectively. The sensitivity, specificity, and positive predictive value of specific benign findings for an ultimately benign nodule were 58% (95% CI, 51-66%), 95% (86-99%), and 90% (70-97%). The sensitivity, specificity, and positive predictive value of nonspecific benign findings for an ultimately benign PPL diagnosis were 32% (95% CI, 25-39%), 19% (9-33%), and 20% (16-24%). CONCLUSION(S): A definition of diagnostic yield excluding nonspecific benign findings had low false positive/negative rates. If bronchoscopy is not diagnostic of malignancy, a specific benign finding was highly predictive of an ultimately benign PPL, while nonspecific findings poorly predicted benignity. CLINICAL IMPLICATIONS: This definition of diagnostic yield could be used as the primary outcome in future studies, permitting distribution of reliable diagnostic results without requiring years of follow-up. DISCLOSURES: No relevant relationships by Joyce Johnson No relevant relationships by Robert Lentz No relevant relationships by Kaele Leonard No relevant relationships by See-Wei Low PI ofan investigator-initiated study relationship with Medtronic Please note: >$100000 by Fabien Maldonado, value=Grant/Research Support PI on investigator-initiated relationship with Erbe Please note: $5001 - $20000 by Fabien Maldonado, value=Grant/Research Support Consulting relationship with Medtronic Please note: $5001 - $20000 by Fabien Maldonado, value=Honoraria co-I industry-sponsored trial relationship with Lung Therapeutics Please note: $5001 - $20000 by Fabien Maldonado, value=Grant/Research Support Board of director member relationship with AABIP Please note: $1-$1000 by Fabien Maldonado, value=Travel Consultant relationship with Medtronic/Covidien Please note: $1001 - $5000 by Otis Rickman, value=Consulting fee No relevant relationships by Briana Swanner Copyright © 2022 American College of Chest Physicians

Assessing ROSE for adequacy of EBUS-TBNA compared with a direct-to-cell block approach as a response to the COVID-19 pandemic.

INTRODUCTION: Rapid on-site evaluation (ROSE) has been used during the endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) procedure as standard practice. Because of the COVID-19 (coronavirus disease 2019) pandemic, our institute had had to discontinue ROSE and adopt a direct-to-cell block approach. In the present study, we aimed to determine whether this change has had significant effects on the cytopathology quality. MATERIALS AND METHODS: A total of 1903 EBUS-TBNA cases from 734 patients were collected (1097 cases with ROSE for 452 patients; 806 cases without ROSE but with direct-to-cell block for 282 patients). The clinical and cytology data were analyzed using SAS, version 9.4, software to render calculated standardized residuals and a fitted multivariate generalized linear model. RESULTS: On average, a biopsy from a patient with ROSE was 0.936 (=exp -0.066) times less likely to be reported as satisfactory compared with a biopsy from a patient without ROSE, although the difference was not statistically significant (P = 0.785). The inadequacy rate of EBUS-TBNA was 6.4% higher on average for cases with ROSE compared with a direct-to-cell block approach. However, this difference was also not statistically significant. The proportions of biopsies reported as diagnostic for malignancy and other were significantly different between the ROSE and no-ROSE groups with a standardized residual of 1.80 (P = 0.036) and -2.27 (P = 0.012), respectively. CONCLUSIONS: Discontinuing ROSE and using a direct-to-cell block approach had no negative effects on cytopathology quality. This practice can be considered acceptable during the COVID-19 pandemic when social distancing and the shortage of staff and supplies have resulted in challenges to delivering quality care to cancer patients whose treatment cannot be postponed.

Quantifying the hidden impact of COVID-19 pandemic: The cytology perspective.

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.

Evaluation of COVID-19-Related Changes in Cytopathology Case Volume at a Large County Hospital in Texas

Background: COVID-19 has significantly changed the way we live and work and has caused clear disruptions in the number of cases received by pathology departments across the world. These changes have not been evaluated to determine what areas of pathology showed the greatest decreases in numbers, particularly within cytopathology. In this study, we evaluated the trends of cytopathology practice before, during and after the initial surge of COVID-19 at our county hospital (Ben Taub Hospital) in one of most populated counties in the United States. Design: A retrospective review of our institutional database was performed to examine the numbers of cytopathology cases from June 2019 to June 2021. Cytopathology cases were stratified into the broad categories of gynecologic (GYN), non-gynecologic (non-GYN) and fine needle aspiration (FNA) cases. Results: The number of GYN cases had the sharpest decline of approximately 90% during the acute phase of the COVID-19 pandemic in the spring of 2020 (Figure 1), starting in late February (n=1407) and March (n=829), with a trough in April 2020 (n=154). Following this initial significant decline, GYN cases began to increase in May 2020 and later;however, the GYN case volume never returned to the pre-pandemic level. Meanwhile, the number of FNA cases during same period had a decline (n=92 in February, n=73 in March, and n=54 in April), though not as dramatic as for GYN cases (Figure 2A). The volume of FNA cases never reached pre-pandemic levels, but there was nearly a complete recovery. Similarly, the quantity of non-GYN cases decreased (n=136 in February, n=113 in March, and n=96 in April), but the acceleration of the decline was much slower. The number of non- GYN cases eventually returned to pre-pandemic levels in October 2020 (Figure 2B). Volumes of cases in all three areas started to decline again in the late spring and early summer of 2021 as COVID-19 case numbers started to increase once again. Conclusions: The trend in cytopathology cases at our institution demonstrated a dramatic decline for GYN cases, with a less sharp decline in FNA and non-GYN cases during the acute phase of pandemic in the spring of 2020. The large decrease in GYN cases suggests that primary screening was significantly impacted by the pandemic. Whether we should encourage patients to resume in-person visits for GYN screenings or consider changing guidelines to include the effect of COVID-19 pandemic on screening remains to be seen.

Assessing Rapid On-Site Evaluation (ROSE) for Adequacy of Endobronchial Ultrasound Transbronchial Needle Aspiration (EBUS-TBNA) Procedures Compared to A Direct-to- Cellblock Approach As a Response to COVID-19 Pandemic

Background: Rapid on-site evaluation (ROSE) of endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) has been used as standard to improve diagnostic yield and to triage samples for additional testing. A method has been prompted to leveraging the expertise of cytotechnologists only or the utility of tele cytology. However, due to the COVID-19 pandemic, our institution had to discontinue ROSE for EBUS-TBNA, and instead adopted a direct-to-cellblock approach. This study aims to determine if removing ROSE affected the adequacy of samples obtained from the EBUS-TBNA cases, and if this new approach should be employed continuously for an extended period without jeopardizing the standard of care to the patient since we are still in the pandemic. Design: We collected data of total 1903 EBUS-TBNA cases from 734 patients. 1097 cases were performed from 1/2019 to 3/2020 with ROSE on 452 patients;806 cases were performed between 4/2020 to 12/2020 without ROSE on 282 patients, and the sample was sent directly to be processed as a cell block. Data variables collected included patient's age and gender, specimen sites and frequencies, and final cytopathological diagnosis. Calculated standardized residuals and fitted multivariate generalized linear model were performed at Moffitt Cancer Center & Research Institute Biostats Core using software SAS 9.4. Results: On average, holding specimen site variable constant, a biopsy from a patient with ROSE is 0.936 (=exp -0.066) times less likely to be reported as 'Satisfactory' as compared to a biopsy taken from a patient without ROSE, and this difference is not statistically significant (p = 0.785). Among all 6 categories of diagnosis, biopsies reported as 'Diagnostic for malignancy' are significantly different between ROSE and no ROSE groups with the standardized residual of 1.80 (p = 0.036) & only other significantly different category was 'Other';however, a very small number of biopsies were reported in this category (3.5%). Conclusions: The inadequacy rate of EBUS-TBNA was 6.4% higher on average in cases with ROSE when compared to a directto- cell block approach in this data set, however this difference was not statistically significant. This suggests that ROSE could be discontinued in favor of a direct-to-cell block approach. Although additional studies are needed, the discontinuation of ROSE for EBUS-TBNA would decrease the time and cost burden on cytopathology service while providing the same quality of care to the patient. (Table Presented).

Gynecological Pathology Journal Club: A 17 Month, Worldwide Virtual Learning Experience with a Focus on Mentorship and Inclusion

Background: Journal Clubs (JC) are a common format used in teaching institutions to promote trainee engagement and develop skills of seeking out evidence-based medicine and critically evaluating literature. Digital technology has made these formats accessible to worldwide audiences, which allows for increased inclusion of globally diverse presenters and attendees. Herein we describe the experience of the first 17 months of a virtual gynecologic pathology journal club designed with the goal of increasing inclusivity and providing mentorship to trainees and early career pathologists. Design: JC began in a virtual format in April of 2020 as a response to the necessity of remote learning during the Covid-19 pandemic. Each JC had one moderator, lasted one hour, featured up to three trainees/early career pathologists, and covered articles on gynecologic surgical pathology/cytopathology. Recruitment of trainees was performed via direct contact by moderators and via social media. Prior to presenting, feedback was provided, and live practice was conducted with the moderator. A template was used for presentation. Evaluations were provided to presenters and attendees for feedback. Recordings of the meetings were made publicly available following the events via YouTube, a society website, and directed emails sent to registrants. Results: 37 unique presenters participated, presenting 50 articles, and most were trainees (32/37;86%) from North America (23/37;62%), with additional presenters from Asia (7/38;18%), Europe (3/38;8%), Africa (3/38;8%), and Australia (2/38;5%). An average of 6 hours were spent per month on mentorship/feedback. Live events had a total of 905 attendees, and recordings were watched 7,923 times. Amongst those who self-identified on provided surveys, the attendees were most commonly from Europe (73/179;41%) and were overwhelmingly practicing pathologists (189/236;80%;Figures 1 and 2). The experience, including mentorship, format, and content were positively reviewed by attendees and presenters (Table 1). Conclusions: JC is an inclusive educational opportunity which was able to engage trainees and early career pathologists from around the globe. In addition, the JC was widely viewed by attendees from multiple countries, the majority of whom were practicing pathologists. Based on feedback, JC expands the medical knowledge of the attendees and empowers presenters to develop their expertise and communication skills.

Telecytopathology for Rapid On-Site Evaluation (ROSE) Adequacy in Fine-Needle Aspiration of Pancreatic and Lung Lesions during COVID19 Pandemic

Background: Telecytopathology (TCP) has a variety of different applications in clinical practice and is becoming more widely utilized especially during COVID pandemic. More recently, TCP use has been increasingly applied to the rapid on-site evaluation (ROSE) at our institution with immediate assessment by viewing cytologic smears remotely over web conferencing platform (zoom). As part of our quality control evaluation, we retrospectively investigated ROSE adequacy in two of the busiest FNA procedures at our institute (pancreas and lung) via TCP. Design: The study includes retrospective review of 151 of pancreatic lesions and 242 lung lesions over a two-year period. The air dried Diff-Quick slides were evaluated on site for adequacy by the cytopathology fellow/ cytotechnologist and cytopathologists via TCP at the same time. The ROSE adequacy diagnosis is recorded and transcribed to the preliminary report. We reviewed the adequacy and preliminary ROSE assessment and compared it to the final diagnosis as the gold standard. The non-diagnostic rate and discrepancy rate between initial and final diagnosis were calculated. Results: A total of 393 adequacy assessments of pancreas (151, 38%) and lung (242, 62%) were analyzed. Overall, 114 (75%) pancreatic cases and 199 (82%) lung lesions had adequate diagnosis at the time of the ROSE, while 37 (25%) of pancreatic cases and 43 (18%) of lung cases had non-adequate ROSE read specimens. Concordance between initial assessment of diagnosis and the final cytological diagnosis was identified in 94% (142 out of 151) of pancreatic cases and 93.4% (226 out of 242) of lung cases. Of the discordant cases, the final diagnosis was upgraded to adenocarcinoma in 7/9 pancreatic lesions and either SCC, adenocarcinoma or atypia in 5/16 lung lesions. The final diagnosis was downgraded to benign category in 2/9 pancreatic lesions and 11/16 lung lesions. Conclusions: Telecytopathology ROSE evaluation of pancreatic and lung lesions may have several advantages over in-person ROSE, including providing a suitable alternative technology, mitigating disease transmission during the COVID19 pandemic, while maximizing resources to allow more efficient use of the pathologist's time, thereby improving efficiency, eliminating downtime, and answering the increasing demand for on-site adequacy evaluation.

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

Lung cancer is a leading cause of cancer mortality worldwide but recent years have seen a rapidly rising proportion of cases of advanced non-small cell carcinoma amenable to increasingly targeted therapy, initially based on the differential response to systemic treatment of tumours of squamous or glandular differentiation. In two-thirds of the cases, where patients present with advanced disease, both primary pathological diagnosis and biomarker testing is based on small biopsies and cytopathological specimens. The framework of this article is an overview of the technical aspect of each stage of the specimen pathway with emphasis on maximising potential for success when using small cytology samples. It brings together the current literature addressing pre-analytical and analytical aspects of specimen acquisition, performing rapid onsite evaluation, and undertaking diagnostic and predictive testing using immunocytochemistry and molecular platforms. The advantages and drawbacks of performing analysis on cell block and non-cell block specimen preparations is discussed.

Effect of the COVID outbreak on detection of second primary breast cancer and breast cancer recurrences

Introduction: The COVID-19 pandemic led to a decrease in the incidence of breast cancer diagnoses in the Netherlands. This was due to the encouragement to stay at home, a lack of capacity at the general practitioner (GP) and an increased reluctance of patients to visit the GP. Moreover, from the 16th of March the Dutch breast cancer screening program was halted and gradually restarted from June onwards. Part of the follow-up visits for breast cancer survivors were also postponed or changed to an appointment by phone. However, it is not known how this affected the incidence of second primary breast cancer (SPBC) and pathologically confirmed breast cancer recurrences. Objective: To investigate the effect of the COVID-19 pandemic on the diagnosis of SPBC and breast cancer recurrences. Methods: Women diagnosed with a pathological confirmed SPBC or recurrence (locoregional recurrences (LRR) + distant metastasis (DM)) between January 1st 2017 and February 28th 2021 were selected from the Netherlands Cancer Registry, based on diagnoses of the Nationwide Histopathology and Cytopathology Data Network and Archive (PALGA). Patients with a SPBC or recurrence who had their primary breast tumor diagnosed more than five years ago were excluded. March 1st 2020 till February 28th 2021 was regarded as the S COVID-19 period. Incidence was expressed per 100, 000 women, who were diagnosed with breast cancer less than 5 years ago, and who were still alive. Incidence of SPBCs and recurrences was calculated for the total COVID-19 period and for four subperiods, and compared with the corresponding periods in 2017/2019 (averaged). Results: A total of 393 patients were diagnosed with a SPBCs in 2017, 340 in 2018, 299 in 2019, 342 in 2020 and 71 up to February 2021. A total of 447 patients were diagnosed with a recurrence in 2017, 520 in 2018, 516 in 2019, 529 in 2020 and 80 up to February 2021. During the COVID-19 period a total of 449 patients were diagnosed with a SPBCs per 100, 000 breast cancer survivors, this was comparable to the 445 patients diagnosed per year per 100, 000 breast cancer survivors in 2017/2019 (p=0.91) (Table 1). The incidence of SPBCs was significantly lower during March-May 2020 compared to the same period in 2017/2019 (86 vs. 121) (p=0.03), leading to 50 less SPBCs diagnoses. The incidence was higher during June-August 2020 (124 vs. 95), however this was not significant (p=0.09). The incidence of recurrences in the COVID-19 period, and within all four subperiods, was comparable to the incidence in 2017/2019. Conclusion: The COVID-19 pandemic led to a decrease in the detection of SPBCs at the beginning of the pandemic. However, this drop in incidence was caught up in the period thereafter. This might be related to the restart of the regular follow-up visits (partly in real-life consultations), the call to go to the GP in case of complaints and the improved accessibility of the GPs. The incidence of recurrences did not decrease since it includes also DM, which cause worrisome symptoms for which care is sought.

Impact of COVID-19 pandemic on diagnostic pathology in the Netherlands.

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.

Indian Academy of Cytologists National Guidelines for Cytopathology Laboratories for Handling Suspected and Positive COVID-19 (SARS-CoV-2) Patient Samples.

COVID-19, caused by the SARS-CoV-2 virus, has been declared a pandemic by the World Health Organization. This scenario has impacted the way we practice cytopathology. Cytology laboratories receive fresh and potentially infectious biological samples including those from the respiratory tract, from COVID-19 positive or suspected patients. Hence, the Indian Academy of Cytologists thought it necessary and fit to bring forth appropriate guidelines starting from transportation, receipt, processing, and reporting of samples in the COVID-19 era. The guidelines are prepared with the aim of safeguarding and protecting the health care personnel including laboratory staff, trainees and cytopathologists by minimizing exposure to COVID-19 so that they remain safe, in order to able to provide a continuous service. We hope that these national guidelines will be implemented across all cytopathology laboratories effectively.

COVID-19 pandemic impact on cytopathology practice in the post-lockdown period: An international, multicenter study.

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.