<scp>COVID</scp> ‐19's Shadow: The Effect of <scp>COVID</scp> ‐19 on Cytopathology Specimens Received at an Academic Laboratory in Central South Africa

Abstract

INTRODUCTION: The COVID-19 pandemic severely disrupted healthcare delivery worldwide, including cytopathology services essential for timely diagnosis and management of malignancies. This study evaluated the pandemic's impact on cytopathology specimen trends at the National Health Laboratory Service (NHLS) Universitas Academic Hospital laboratory in central South Africa. METHODS: A retrospective analysis was conducted on adult non-gynaecological cytology specimens from March 2018 to April 2024, divided into pre-COVID-19, COVID-19, and post-COVID-19 eras. Specimens were categorised into fine needle aspirates (FNAs) and other non-gynaecological specimens, and stratified by anatomical site and diagnosis (benign, malignant, and suspicious for malignancy). Unsatisfactory, paediatric, and inadequate samples were excluded. Time series analysis was used for comparisons. RESULTS: Specimen volumes declined significantly during the COVID-19 era (p < 0.001) and did not recover in the post-pandemic era. Although the proportion of FNAs remained consistent, specific trends were observed, including a marked decline in breast FNAs and benign diagnoses, with a concurrent increase in malignant and cases that were suspicious for malignancy. Respiratory tract FNAs increased during the COVID-19 era, reflecting a shift in clinical priorities. CONCLUSION: Cytopathology services in central South Africa experienced sustained reductions in the volume of specimens received during and after COVID-19. Increased malignant diagnoses may reflect delayed presentations and diagnostic backlogs created by the lockdown periods. These findings highlight the importance of resilient diagnostic services during health crises, as well as the importance of relying on more cost-effective and faster diagnostic tools, such as cytopathology.