Impact of the COVID-19 Pandemic on the Diagnosis of Malignant Uterine Tumors in Romania: A Retrospective Single-Center Pathology-Based Study

Background: The COVID-19 pandemic caused severe disruptions in healthcare systems, raising major concerns regarding delayed oncological diagnoses. This study aimed to evaluate the impact of the pandemic on the volume and clinicopathological characteristics of malignant uterine tumors in a tertiary referral pathology center. Methods: We conducted a retrospective observational study of 286 patients diagnosed with primary malignant uterine tumors between 2017 and 2024. Cases were grouped into three periods: pre-pandemic (2017–2019, n = 94), pandemic (2020–2021, n = 53), and post-pandemic (2022–2024, n = 139). Annual trends and changes in tumor grade, histological subtype, pathological T category (pT), FIGO stage, lymphovascular space invasion (LVSI), and perineural invasion (PNI) were analyzed. Results: A marked decline in diagnostic volume was observed during the pandemic, reaching its lowest point in 2021 (16 hysterectomies and 5 curettages), followed by an increase above pre-pandemic levels in the post-pandemic years. No statistically significant differences were found across the three periods regarding patient age (p = 0.555), histological subtype (p = 0.486), or tumor grade (p = 0.422). For the 227 hysterectomy specimens, detailed pT (p = 0.017) and FIGO stage (p = 0.031) distributions varied, but grouped analyses showed no shift toward advanced disease (pT3–pT4, p = 0.537; FIGO III–IV, p = 0.438). LVSI remained stable (p = 0.807), while PNI rates increased significantly during the pandemic (p = 0.014). Conclusions: The COVID-19 pandemic was associated with a transient reduction in diagnosed malignant uterine tumors, peaking in 2021. Despite this reduction in diagnostic volume, no statistically significant increase in the proportion of advanced-stage tumors was observed among patients undergoing definitive surgery. However, the available data do not allow conclusions regarding diagnostic delays or changes in referral pathways.