Within the session entitled “The lung pathologist in the Covid-19 pandemic,” speakers detailed how the pandemic has affected patients, diagnosis and clinical trials, yet also highlighted the changes pathologists had noted and detailed in lung characteristics as the pandemic progressed. This, said speakers, contributed to a better understanding of Covid-19 and helped shape the response.
Professor Paul Hofman from the Laboratory of Clinical and Experimental Pathology at the Louis Pasteur Hospital in Nice, France, examined the reasons for the decrease in management of lung cancer patients, and the consequences of the Covid-19 pandemic for thoracic pathology laboratories in Europe. In his presentation, “Lung cancer in the Covid-19 pandemic”, he said patients with lung cancer avoided hospitals because they feared being infected with SARS-CoV-2, and how that would affect their condition.
Care of lung cancer patients was also delayed by when appointments and treatment programmes were cancelled. “Lung cancer patients were not treated adequately due to extensive devotion of many physicians to Covid-19 patients,” added Professor Hofman. “Staff members from pathology laboratories were reoriented to work in emergency clinical departments to take part in different activities against Covid-19.” This resulted in a decrease in molecular analysis in lung cancer during the different waves of the pandemic, particularly in the molecular pathology analyses for genomic alteration assessment in lung cancer.
There was also a lower number of patients being included in clinical trials and Professor Hofman highlighted challenges and issues surrounding the use for translational research of human samples obtained during the Covid-19 pandemic from lung cancer patients.
Because of issues of biosafety measures and biospecimen handling, there was a decrease of specimens for diagnosis, and fewer collected samples also disrupted translational and basic non-Covid-19 research. A shortage of personnel also impaired routine work and research. However, on the positive side, there was a contribution to research on Covid-19 pathogenesis/pathology and a better understanding of the disease.
In addition, the biological safety for personnel working in the pathology lab during Covid-19 had to be carefully assessed and managed with correct training and protocols.
Role of pathologists
Lung pathologists were particularly able to observe the changes taking place in the lung over the waves of the pandemic. Professor Fiorella Calabrese from the Department of Cardiac, Thoracic, Vascular Sciences and Public Health (University of Padova, Italy), spoke on the subject and covered current knowledge of pathological lung lesions of Covid-19; and how to recognise and describe the major pathological lung differences through pandemic waves.
She said pathologists had made an important contribution in this respect and had shown that from the first wave, there were three main phenotypes: with prevalent Alveolar Injury (AI); with prevalent Vascular Injury (VI); and with both (mixed type).
During the second wave, the most significant difference was higher frequency of fungal infection, and in particular aspergillus, she said. “In terms of the important contribution of pathology, and the impact on clinical management, it had delivered clear-cut evidence of different injuries: e.g. vascular lesions. This has increased awareness about some therapeutic strategies (thromboprophylaxis),” said Professor Calabrese.
There had been identification of different pathological phenotypes in patients with severe disease and that had led to the development of mathematic algorithms to predict different phenotypes. There were also extensive tissue analyses from full autopsies, and that increased a broader understanding of the causes of death as not all patients died due to severe Covid-19 pneumonia. “With more superimposed infections - in particular fungal infections (CAPA) - that helped enable the development of diagnostic procedure for a more sensitive detection of proven CAPA,” added Dr Calabrese.
The session also heard from Professor Zsuzsanna Varga from University Hospital Zurich, who discussed viral detection in the lung specimens, and Professor Ines Testoni from the University of Padova who discussed how pathologists had reacted to the pandemic.
Professor Paul Hofman from the Laboratory of Clinical and Experimental Pathology at the Louis Pasteur Hospital in Nice, France, is Full Professor, Head of Human Biobank Unit at the University of Nice and of the FHU OncoAge. He obtained an MD at the University of Nice Sophia Antipolis and a PhD at the University of Montpellier and has published more than 500 articles in peer-reviewed journals.
Professor Fiorella Calabrese is a full professor in the Department of Cardiothoracic and Vascular Sciences at the University of Padova, Pathology Section. Her research interests include pulmonary pathologies, transplant pathologies, molecular pathology, infectious and immunological diseases, and cardiomyopathies. Dr Calabrese is the author of 280 publications in peer-reviewed journals, and past chair of the European Society of Pathology (ESP) Pulmonary Pathology Working Group.