key: cord-0984178-rv9f8l2i
authors: Rabe, Kimmie; Chauhan, Aastha; Holler, Jana; Mettler, Tetyana; Amin, Khalid; Stewart, Jimmie
title: Effects of COVID-19 Pandemic on Cytology: Specimen Adequacy in Fine Needle Aspiration of Palpable Head and Neck Masses
date: 2022-04-19
journal: J Am Soc Cytopathol
DOI: 10.1016/j.jasc.2022.04.002
sha: 5f0a9c3e479c6723d3094760ced30e5e9a4f337e
doc_id: 984178
cord_uid: rv9f8l2i

Introduction At our institution, palpation guided fine needle aspiration (FNA) is performed by the cytopathology service on an outpatient basis at the request of otolaryngologist surgeons. The aim of this study is to assess the effect of COVID lockdown measures on our fine needle aspiration (FNA) service with specific focus on adequacy rates. Materials and Methods All palpation guided FNA performed in 2019-2020 were identified in our pathology database. Adequacy rates were compared for 3 time periods in 2020: pre-COVID, lockdown, and post-lockdown. Results In 2019, 121 FNAs were performed with 98% (119/121) obtained by pathology and only 2% (2/121) obtained by surgeons. In 2020, 89 FNAs were performed with 45% (40/89) collected by pathologists and 55% (49/89) by surgeons. During the pre-COVID period of 2020, 27 FNAs were collected, 85% (23/27) by pathologists, 8.7% of these (2/23) were non-diagnostic. Of the 4 FNAs performed by surgeons, all were positive for malignancy. During COVID lockdown all 24 FNAs were performed by surgeons with a 50% (12/24) non-diagnostic rate. Post-lockdown, with FNA referrals still below pre-COVID levels, surgeons performed 55.3% (21/38) of FNAs with 28.6% (6/21) non-diagnostic, while pathology performed 44.7% (17/38) with an 11.8% (2/17) non-diagnostic rate. Conclusions Our FNA service noted significant changes in 2020 as a result of the COVID pandemic. Non-diagnostic rates were significantly increased in 2020 compared to 2019, primarily due to a shift to majority surgeon-performed palpation guided FNA in the absence of cytopathology service during the lockdown period.

due to a shift to majority surgeon-performed palpation guided FNA in the absence of cytopathology service during the lockdown period. Walz declared a state of emergency on March 13, 2020 1 and our hospital system postponed all elective surgeries at its hospitals and clinics, effective March 18, 2020 2 , due to the novel coronavirus. Our hospital system anticipated shortages in personal protective equipment (PPE) and due to the need to conserve PPE at the clinic site, the cytopathology department had halted the performance of FNA as early as March 4, 2020 . This continued through July 14, 2020.

The aim of this study was to examine the adequacy rates of FNAs performed on palpable head and neck masses at our institution in 2020. We also hoped to assess the effect of COVID lockdown measures on our CYP service.

J o u r n a l P r e -p r o o f Discussion:

The COVID-19 pandemic has affected all aspects of health care delivery including the cytopathology laboratory. During lockdown periods, cytopathology laboratories around the world saw significant decreases in specimen volume [4] [5] [6] [7] [8] [9] . Our laboratory experienced a 13.25% decrease in specimen volume in 2020 compared to 2019. This included a 26% decrease in the total number of palpation guided FNA and a 66% decrease in the number performed by CYP. The complete 4-month cessation of our FNA service led to a significant increase in the number of non-diagnostic palpation guided FNA specimens during the shutdown and for all of 2020. We have yet to see a complete post-COVID shutdown recovery of service volume.

FNA is valuable for the initial evaluation of superficial, palpable masses of the head and neck. It is a fast, simple, minimally invasive and cost-effective procedure. High levels of accuracy, sensitivity and specificity are reported for salivary gland and neck masses [10] [11] [12] . Diagnostic accuracy can be influenced by the use of cytology support services. ROSE has been shown to decrease the number of non-diagnostic specimens by offering immediate feedback and appropriate triage of specimens [13] [14] [15] There are numerous factors that may influence FNA adequacy rate other than one-site cytologic evaluation or operator experience. These variables include use of imaging guidance, needle gauge, number of needle passes, nodule size or depth, and lesion characteristics such as sclerosis or cystic degeneration. We did control for the use of ultrasound guidance. However, a number of these variables are not routinely documented in the patient chart or pathology report, and were not specifically examined in our study. This makes it difficult to suggest how manipulation of these procurement elements may lead to improved sample collection.

In summary, our study shows that the quality of aspiration specimens declined over the pandemic as a direct result of the absence of cytopathology support. Adequacy Totals are for all operators (CYP and surgeons). There are no significant differences in malignancy rate for any time period. 

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The authors have no conflicts of interest to disclose.Funding information: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

• Shutdowns related to the COVID-19 pandemic in 2020 had a dramatic effect on the palpation-guided fine needle aspiration (PGFNA) service at our academic institution • As compared to 2019, there was a significant decrease in the total number of PGFNAs performed as well as a shift to majority surgeon-performed PGFNA • Non-diagnostic rates were significantly increased in 2020 as compared to 2019 due to the absence of cytopathology services during the lockdown period • Cytopathologists have distinct advantages in the performance of PGFNA including experience and on-site cytologic evaluation of collected material