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

SARS-CoV-2 and Molecular Predictive Pathology

During the COVID-19 healthcare emergency, elective surgeries and medical procedures scheduled as non-urgent were postponed.[18,38–42] In particular, any screening procedure was temporarily suspended, including breast cancer screening program, colonoscopy to investigate positive immunohistochemical fecal occult blood tests, cervical uterine cytology and prostate specific antigen (PSA) screening.[11] Similarly, molecular screening of genetically based neoplastic diseases was also postponed.[11] In this setting, BRCA gene testing is an exemplificative case. In fact, it was postponed when performed to evaluate the hereditary cancer risk patients' relatives, conversely it was carried out without delays for those patients with ovary neoplasia to evaluate olaparib as a target therapy option for patients harboring alterations for homologous recombination deficiency (HRD).[43] As far as lung cancer predictive biomarker testing is concerned, in our and in other laboratories no significant variation in the total number of tested cases was observed.[10] However, molecular laboratory activities required reshaping and reorganizing the genotyping workflow, to guarantee laboratory staff security.[10,44] In this scenario, fully automated technologies, requiring minimal hands-on work, were adopted to limit the amount of time spent by the laboratory staff to process lung cancer samples.[10] In fact, in our laboratory the standard technology represented by next generation sequencing that requires a long workflow and more than one operator was in almost all cancer cases (92.7%; 38/41), including lung cancer samples, replaced by the robotic Idylla platform (Biocartis, Mechelen, Belgium) (Figure 1E,F,G,H).[10] A reduction in the number of samples processed was reported only for liquid biopsy testing, reflecting the potential source of transmission, pointing out the need of timely recommendation that should be provided soon to regulate this activity.[10] Recently, a multi-centric study investigated the effect of COVID-19 pandemic on lung cancer molecular pathology. Results obtained from 15 European laboratories showed that the number of cases processed during the lockdown (n=1,118) was very similar to that of a corresponding period in 2019 (n=963).[45]