A Narrative Review of Lung Cancer Cytology in the Times of Coronavirus

What Physicians Should Know

Pasquale Pisapia; Umberto Malapelle; Maria Salatiello; Rafael Rosell; Giancarlo Troncone


Transl Lung Cancer Res. 2020;9(5):2074-2081. 

In This Article

Abstract and Introduction


In the modern era of personalized and precision medicine, lung cancer management needs to be carried out in a multidisciplinary manner. Among other disciplines, also cytopathology is key in diagnosis and treatment management of these patients. Indeed, cytopathology specimens are often the only source of available tissue material for morphological diagnosis and molecular purposes in order to guarantee an adequate treatment decision making, since surgical resection specimens are not available when lung cancer is diagnosed at advanced disease stages. Today, as an effect of the current severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) pandemic, cytopathology is reorganizing and reshaping many of its procedures and workflows, in order to ensure the safety of cytopathologists and laboratory personnel. In particular, careful attention should be paid on biosafety procedures when pulmonary cytological specimens are handled. In addition, also molecular cytopathology, that provides relevant information on the molecular status and on the potential sensitivity to target treatments, is undergoing major changes. In this setting, fully automated technologies, requiring minimal hands-on work, may be a valid option. The aim of this narrative review is to keep updated all the different professional figures involved in lung cancer management and treatment on how SARS-CoV-2 is modifying lung cancer cytopathology.


The care of any single lung cancer patient requires an integrated approach and a thoroughly collegial discussion taking place at the institutional lung cancer multidisciplinary team (MDT) table to ensure a timely diagnosis, a complete staging, adherence to international guidelines and opportunities for clinical trial recruitment.[1,2] In the MDT, together with oncologists, surgeons, pneumologists, radiologists, molecular diagnosticians and clinical bioinformaticians, also cytopathologists play a central role.[3] In advanced disease stages, when tumor surgical resection for histological evaluation is not feasible, cytopathology specimens, including both exfoliative and fine needle aspirative biopsy samples, might be the only source of tissue for a complete and fully autonomous diagnosis, including predictive biomarker testing.[4–8] Today, in the times of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, a number of strictly necessary biosafety procedures are changing the way we practice cytopathology.[9] The aim of this review is to briefly update the different MDT professional figures, on these new rules and in particular on those requirements to process fresh cytopathological samples, to perform rapid on site evaluation (ROSE), to employ liquid based cytology (LBC) methodology and to provide relevant information on the molecular status of lung cancer.[10,11] We present the following article, as a result of a deep analysis of the recent international literature published in English on PUBMED in the last six months focused on the impact of SARS-CoV-2 on the management of lung cancer cytological samples, in accordance with the Narrative Review reporting checklist (available at https://dx.doi.org/10.21037/tlcr-20-795).