ÖNEMI BELIRSIZ ATIPI/ÖNEMI BELIRSIZ FOLIKÜLER LEZYON VAKALARININ YÖNETIMINDE INFLAMATUAR PARAMETRELERIN ROLÜ

Yıl 2023, , 131 - 135, 30.09.2023

Marlen Süleyman , Rıfat Bezirci

https://doi.org/10.20492/aeahtd.1342736

Öz

AMAÇ: Bu çalışma, biyopsi sonucu Önemi Belirsiz Atipi/Önemi Belirsiz Foliküler Lezyon (ÖBA/ÖBFL) olarak sınıflandırılan hastalarda hematolojik parametreler ve nötrofil-lenfosit oranı (NLO), platelet-lenfosit oranı (PLO), monosit-lenfosit oranı (MLO), sistemik immün-inflamasyon indeksi (Sİİ), sistemik inflamasyon yanıt indeksi (SİYİ) gibi ve belirteçlerin malignite riskini öngörü potansiyelini değerlendirmeyi amaçladı.

GEREÇ VE YÖNTEM: Bir Genel Cerrahi kliniğinde tiroidektomi yapılan toplam 188 hasta çalışmaya dahil edildi. Nötrofil sayısı, trombosit sayısı, lenfosit sayısı, monosit sayısı ve ortalama platelet hacmi (OPH) gibi hematolojik parametreler hastane veri tabanından toplandı. NLO, PLO, MLO, Sİİ ve SİYİ hesaplandı. İstatistiksel analizler SPSS v25 kullanılarak yapıldı.

BULGULAR: 38 hasta (%20,21) erkek ve 150 hasta (%79,79) kadındı. Ortalama yaş 48.6 (dağılım 23-79, SD ± 12,41 yıl) idi. Tiroidektomi örneklerinin histopatolojik incelemesinde 102 hastada (%54,3) benign, 86 hastada (%45,7) malign bulgular saptandı. Malign grubun yaş ortalaması 45,6 iken, benign grubun yaş ortalaması 51,1 idi (p = 0,02). Ortanca tümör boyutu malign grupta 17 mm, benign grupta ise 21 mm idi (p =0,042). Ortalama nötrofil sayısı sırasıyla benign grupta 4,29 ± 1,0 × 109/L ve malign grupta 4,69 ± 1,9 × 109/L idi (p = 0,031). NLO değerleri benign grup için 1.89 ve malign grup için 1,99 olarak hesaplanmıştır (p = 0.045). Sİİ değerleri malign grupta daha yüksek saptanmıştır, malign grupta medyan değer 584,11×109/L iken, benign grupta medyan değer 504,63×109/L'dir (p=0,037).
Çok değişkenli lojistik regresyon analizi, hem yaşın (odds oranı (OR) = 0,964; %95 güven aralığı (CI)= (0,939- 0,989); p = 0,05) hem de nötrofil sayısının OR = 1,598; %95 CI= (1,118- 2,285); p = 0,01) benign ve malign tiroid nodülleri arasındaki ayrım üzerinde önemli bir etkisi olduğunu göstermiştir.
SONUÇ: Yaş ve nötrofil sayısı malign tiroid nodülleri için bağımsız risk faktörleri olarak belirlenmiştir. Bethesda Kategori III tiroid nodülü olan hastalar arasında, 59,5 yaşın altında ve nötrofil sayısı 4,16 x 10^9/L'nin üzerinde olanlar tiroid malignitesi için artmış riske sahiptir.
Trombosit sayısı, monosit sayısı ve PLO, MLO ve SİYİ gibi enflamatuar parametreler Bethesda III nodüllerinde maligniteyi tespit etmek için yetersiz bulunmuştur. Bu grupta genç yaş, küçük nodül boyutu, yüksek nötrofil sayısı, NLO ve Sİİ malignite için risk faktörleri olarak tanımlanmıştır. Bu hastaların yönetiminde nodüllerin The Thyroid Imaging Reporting and Data System (TI-RADS) özellikleri de göz önünde bulundurulmalıdır.

Anahtar Kelimeler

Bethesda raporlama sistemi, Önemi belirsiz atipi/önemi belirsiz foliküler lezyonlar, nodüller, Tiroid kanseri, biyobelirteç

Destekleyen Kurum

Yok

Proje Numarası

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The role of inflammatory parameters in the management of cases with atypia of undetermined significance/follicular lesions of undetermined significance

Öz

AIM: This study aimed to evaluate the potential of hematologic parameters and markers such as neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) to predict the risk of malignancy in patients whose biopsy results were classified as Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance (AUS/FLUS).
MATERIAL AND METHOD: A total of 188 patients who underwent thyroidectomy at a General Surgery clinic were included in the study. Hematological parameters, including neutrophil count, platelet count, lymphocyte count, monocyte count, and mean platelet volume (MPV) were collected from the hospital database. NLR, PLR, MLR, SII, and SIRI were calculated. Statistical analyses were performed using SPSS v25.
RESULTS: 38 patient (20.21%) were male and 150 patients (79.79 %) were female. The mean age was 48.6 (range 23-79, standard deviation (SD) ± 12.41years). Histopathological examination of the thyroidectomy specimens revealed benign findings in 102 patients (54.3%) and malignant findings in 86 patients (45.7%). The mean age of the malignant group was 45.6, while that of the benign group was 51.1 (p = 0.02). The median tumor size was 17 mm in the malignant group and 21 mm in the benign group (p =0.042). Mean neutrophil count were 4.29 ± 1.0 × 109/L in the benign group and 4.69 ± 1.9 × 109/L in malignant group, respectively (p = 0.031). NLR values were calculated as 1.89 for the benign group and 1.99 for the malignant group (p = 0.045). SII values were higher in the malignant group, with a median value of 584.11× 109/L in the malignant group, median value were 504.63× 109/L in the benign group (p=0.037).
Multivariate logistic regression analysis revealed that both age (odds ratio (OR) = 0.964; 95% confidence interval (CI)= (0.939 – 0.989); p = 0.05) and neutrophil count (odds ratio (OR) = 1.598; 95% confidence interval (CI)= (1.118 – 2.285); p = 0.01) had a significant impact on the differentiation between benign and malignant thyroid nodules.
CONCLUSION: Age and neutrophil count were identified as independent risk factors for malignant thyroid nodules. Among patients with Bethesda Category III thyroid nodules, those under 59.5 years of age and with a neutrophil count above 4.16 x 10^9/L have an increased risk for thyroid malignancy.
Platelet count, monocyte count, MPV and inflammatory parameters, such as PLR, MLR, and SIRI, were insufficient for detecting malignancy in Bethesda III nodules. In this group, young age, small nodule size, high neutrophil count, NLR, and SII were identified as risk factors for malignancy. The Thyroid Imaging Reporting and Data System (TI-RADS) characteristics of nodules should also be considered in the management of these patients.

Anahtar Kelimeler

Atypia of undetermined significance/follicular lesions of undetermined significance nodules, Thyroid cancer, biomarker

Proje Numarası

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Kaynakça

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