The impact of COVID-19 in the management of breast radiology units: What we have learned since 2020? A systematic review

During the last years, the COVID-19 pandemic determined different clinical and radiological scenarios, sometimes difficult to manage, in particular in breast units. On these bases, we tried to understand what we have learned and how to improve the management of breast cancer screening and breast cancer patients. We included a total number of 16 studies. Most published papers about managing breast units during the spread of COVID-19 were editorial, followed by original articles and reviews. Even if the COVID spread followed a bimodal distribution, most papers were published during the first wave, without significant improvement in 2021 and 2022, and were published in journals belonging to general speciality, followed by surgical and radiological journals. One of the most common topics reported in the final included studies is prioritizing patients in the clinical setting according to individual characteristics (first of all, age), risk factors, and time since the last imaging examination. For biopsies, prioritization has been suggested according to the risk of malignant lesions. In the screening setting, this was suspended in most reported studies, also for BRCA+ patients, and then resumed with different modalities according to different centres. Moreover, some proposed the establishment of mobile units for screening or the decentralization of more screening mammograms to smaller clinics or hospital admittance for screening patients via telemedicine. The majority of analyzed papers underlined that all patients, before admittance into the diagnostic rooms, should be screened for suspicious symptoms directly on-site or by asking by phone. In the case of patients with a high suspicion of COVID-19 infection, some papers proposed to delay all breast imaging studies and others to use dedicated departments or areas of the cancer center. In this setting, telemedicine for radiologists has also been suggested. Moreover, other suggestions should be considered: reducing patients' time in the hospital, increasing the distance between patients in the waiting room, and creating additional waiting areas.