COVID-19 lockdown reduces screening and follow-up in urinary cytology Introduction: The national lockdown due to coronavirus disease 2019 (COVID-19) wholly altered our cytology lab's daily practice. We wanted to know how COVID-19 changed the number and composition of urinary specimens as a classic example of a cytological screening and follow-up procedure. Methods: The overall numbers and percentages of urinary cytology (voided urine, bladder washings, washings from the upper urinary tract) were processed at the University Medical Center Hamburg-Eppendorf during the first four weeks of Germany's national lockdown were compared with those of the equivalent period in 2019. All urinary specimens were classified according to the Paris System for Reporting Urinary Cytopathology. Results: During the lockdown, the proportion of urinary specimens significantly dropped from 460 (34,7%) of 1323 total specimen in 2019 to 221 (23,8%) of 928 total specimens (X2-test, p<0.001). The numbers were checked for sample bias of sample senders dynamics. In 2019 of all 460 samples, 385 (83,7%) were voided urine, 56 (12,1%) were bladder washings, and 19 (4,1%) samples were from the upper urinary tract. In 2020 of all 221 samples, 198 (89,6%) were voided urine, 13 (5,9%) were bladder washings, and 10 (4,5%) were washings from the upper urinary tract. The malignancy rate significantly lowered from 14 (3%) of 460 total samples in 2019 to 1 (0,0045%) of 221 whole urine samples in 2020 (Fisher’s exact test p=0.0463). Conclusions: The COVID-19 lockdown reduced the overall case numbers in urinary cytology. The proportions of urine specimens and the urinary cytology's malignancy rates decreased significantly, indicating that bladder cancer screening and follow-up were reduced in the COVID-19 lockdown.
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