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.

Global impact of the COVID-19 pandemic on cytopathology practice: Results from an international survey of laboratories in 23 countries.

BACKGROUND: To the authors' knowledge, the impact of the coronavirus disease 2019 (COVID-19) pandemic on cytopathology practices worldwide has not been investigated formally. In the current study, data from 41 respondents from 23 countries were reported. METHODS: Data regarding the activity of each cytopathology laboratory during 4 weeks of COVID-19 lockdown were collected and compared with those obtained during the corresponding period in 2019. The overall number and percentage of exfoliative and fine-needle aspiration cytology samples from each anatomic site were recorded. Differences in the malignancy and suspicious rates between the 2 periods were analyzed using a meta-analytical approach. RESULTS: Overall, the sample volume was lower compared with 2019 (104,319 samples vs 190,225 samples), with an average volume reduction of 45.3% (range, 0.1%-98.0%). The percentage of samples from the cervicovaginal tract, thyroid, and anorectal region was significantly reduced (P < .05). Conversely, the percentage of samples from the urinary tract, serous cavities, breast, lymph nodes, respiratory tract, salivary glands, central nervous system, gastrointestinal tract, pancreas, liver, and biliary tract increased (P < .05). An overall increase of 5.56% (95% CI, 3.77%-7.35%) in the malignancy rate in nongynecological samples during the COVID-19 pandemic was observed. When the suspicious category was included, the overall increase was 6.95% (95% CI, 4.63%-9.27%). CONCLUSIONS: The COVID-19 pandemic resulted in a drastic reduction in the total number of cytology specimens regardless of anatomic site or specimen type. The rate of malignancy increased, reflecting the prioritization of patients with cancer who were considered to be at high risk. Prospective monitoring of the effect of delays in access to health services during the lockdown period is warranted.

Cáncer neuroendocrino de mama. A propósito de un caso / Neuroendocrine breast cancer. A case report

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Sarcomas de mama posradiación / Radiation-induced sarcomas of the breast

El cáncer de mama es la neoplasia más frecuente en la mujer. El tratamiento conservador implica el tratamiento adyuvante con radioterapia. Alrededor del 60% de los pacientes con cáncer reciben radioterapia durante el curso de su enfermedad. Los sarcomas son tumores raros y corresponden al 0,03-0,8% de toda la patología tumoral. Su origen es controvertido siendo asociado a traumatismos, exposición a agentes químicos, linfedema crónico y radioterapia. El porcentaje de sarcomas radioinducidos supone el 0,1-0,4% de los mismos. Ya en 1904 Perthes y posteriormente Cahan describieron la asociación de radioterapia como desencadenante en la patogénesis de los sarcomas. El mejor conocimiento actual de la biología aporta nuevos indicios sobre su origen. La distancia temporal entre la exposición a la radiación y la aparición del sarcoma es el criterio principal que ha sido modificado por la mayor parte de los investigadores, y está entre 3-10 años. El tratamiento de elección, sigue siendo la cirugía con amplios márgenes de seguridad. Respecto al tratamiento adyuvante, la radioterapia y quimioterapia tienen un efecto limitado. El pronóstico es desfavorable, con una supervivencia global a los 5 años, que oscila del 17-58%, significativamente menor que la de los sarcomas de partes blandas de novo. Debido al escaso número de casos recogidos en la literatura, es difícil definir el protocolo de actuación más correcto, por lo que pretendemos ofrecer una revisión de las manifestaciones clínicas, técnicas de imagen, tratamiento y pronóstico de los sarcomas radioinducidos, aportando a la vez 2 nuevos casos de sarcomas radioinducidos tras neoplasia mamaria (AU)

Breast cancer is the most common neoplasm in women. Conservative treatment involves adjuvant therapy with radiotherapy. About 60% of cancer patients receive radiotherapy during the course of their disease. Sarcomas are rare tumors and account for 0,03-0,8% of all tumoral disease. Their origin is controversial and has been associated with trauma, exposure to chemicals, radiation and chronic lymphedema. The percentage of radiation-induced sarcomas represents the 0.1-0.4% of these tumors. As early as 1904, Perthes, and later Cahan, described the association of radiotherapy as a trigger in the pathogenesis of sarcomas. Greater current knowledge of biology provides new clues to the origin of sarcomas. The time interval between radiation exposure and the appearance of a sarcoma is the main criterion that has been modified by most researchers and is between 3 and 10 years. The treatment of choice is still surgery with wide safety margins. Regarding adjuvant treatment, radiotherapy and chemotherapy have limited effect. Prognosis is poor, with an overall 5-year survival ranging from 17% to 58%, significantly lower than that of de novo soft tissue sarcomas. Due to the small number of cases reported in the literature, it is difficult to define the most appropriate protocol. Consequently, our aim is to provide a review of the clinical manifestations, imaging techniques, treatment and prognosis of radiation-induced sarcomas and to report two new cases of radiation-induced sarcomas after breast cancer (AU)