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

ABSTRACT

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.