Are NLR Rate and MPV Values Useful in Predicting Malignancy in Follicular Neoplasia, Atypia of Undetermined Significance and Suspicious Cytology?

Abstract

Objectives: Neutrophil-to-lymphocyte ratio (NLR), an indicator of systemic inflammation, and mean platelet volume (MPV) have been found to be associated with carcinogenesis in many studies. The aim of this study was to investigate the predictive values of these two parameters in detecting thyroid malignancy. Materials and Methods: Patients who were reported to have atypia of undetermined significance, follicular neoplasia and suspected cytology as a result of thyroid fine needle aspiration biopsy (FNAB) in a tertiary health care facility between January 2010 and December 2017 and who had undergone total thyroidectomy or hemithyroidectomy due to this were evaluated. The data of 225 patients were retrospectively reviewed, and 144 patients (29 females/115 males) were included in the study. Results: When patients found to be malignant and benign as a result of the pathology results were compared, preoperative NLR values were detected to be statistically significant in malignant patients (p=0.002). Preoperative MPV values were found to be statistically insignificant. When compared in terms of FNAB groups, we found a significance only in suspicious cytology (p=0.001) but found no significance in the other groups. Conclusion: NLR may be useful in the differentiation of benign and malignant diseases but still cannot provide clear data for predicting malignancy between FNAB groups.

Keywords

• Neutrophil-to-Lymphocyte Ratio
• Thyroid Surgery
• Mean Platelet Volume

NLR Oranı ve MPV Değeri Foliküler Neoplazi, Önemi Belirsiz Atipi ve Kuşkulu Sitolojide Maligniteyi Öngörmede Yararlı mıdır?

Abstract

References

1. 1. Liu CL, Lee JJ, Liu TP, et al. Blood neutrophil-to-lymphocyte ratio correlates with tumor size in patients with differentiated thyroid cancer. J Surg Oncol. 2013;107:493-497.
2. 2. Luo J, McManus C, Chen H, et al. Are there predictors of malignancy in patients with multinodular goiter? J Surg Res. 2012;174:207-210.
3. 3. Zhou GJ, Xiao M, Zhao LN, et al. MicroRNAs as novel biomarkers for the differentiation of malignant versus benign thyroid lesions: a meta-analysis. Genet Mol Res. 2015;14:7279-7289.
4. 4. Guarino V, Castellone MD, Avilla E, et al. Thyroid cancer and inflammation. Mol Cell Endocrinol. 2010;321:94-102.
5. 5. Larson SD, Jackson LN, Riall TS, et al. Increased incidence of welldifferentiated thyroid cancer associated with Hashimoto thyroiditis and the role of the PI3k/Akt pathway. J Am Coll Surg. 2007;204:764-773.
6. 6. Moore MM, Chua W, Charles KA, et al. Inflammation and cancer: causes and consequences. Clin Pharmacol Ther. 2010;87:504-508.
7. 7. Proctor MJ, McMillan DC, Morrison DS, et al. A derived neutrophil to lymphocyte ratio predicts survival in patients with cancer. Br J Cancer. 2012;107:695-699.
8. 8. Clarke SJ, Chua W, Moore M, et al. Use of inflammatory markers to guide cancer treatment. Clin Pharmacol Ther. 2011;90:475-478.

9. 9. Seretis C, Gourgiotis S, Gemenetzis G, et al. The significance of neutrophil/ lymphocyte ratio as a possible marker of underlying papillary microcarcinomas in thyroidal goiters: a pilot study. Am J Surg. 2013;205:691-696.
10. 10. Han SW, Kang SY, Kim SK, et al. Clinical significance of blood neutrophilto- lymphocyte ratio in patients with papillary thyroid carcinoma. Korean J Endocr Surg. 2014;14:184-189. 11. Kemal Y, Yucel I, Ekiz K, et al. Elevated serum neutrophil to lymphocyte and platelet to lymphocyte ratios could be useful in lung cancer diagnosis. Asian Pac J Cancer Prev. 2014;15:2651-2654.
11. 12. Mangalpally KK, Siqueiros-Garcia A, Vaduganathan M, et al. Platelet activation patterns in platelet size sub-populations: differential responses to aspirin in vitro. J Thrombosis Thrombolysis. 2010;30:251-262.
12. 13. Cho SY, Yang JJ, You E, et al. Mean platelet volume/platelet count ratio in hepatocellular carcinoma. Platelets. 2013;24:375-377.
13. 14. Kemal Y, Demirağ G, Ekiz K, et al. Mean platelet volume could be a useful biomarker for monitoring epithelial ovarian cancer. J Obstet Gynaecol. 2014;34:515-518.
14. 15. Kılınçalp S, Ekiz F, Başar O, et al. Mean platelet volume could be possible biomarker in early diagnosis and monitoring of gastric cancer. Platelets. 2014;25:592-594.
15. 16. Baldane S, Ipekci SH, Sozen M, et al. Mean platelet volume could be a possible biomarker for papillary thyroid carcinomas. Asian Pac J Cancer Prev. 2015;16:2671-2674.
16. 17. Hamberger B, Gharib H, Melton LJ 3rd, et al. Fine-needle aspiration biopsy of thyroid nodules. Impact on thyroid practice and cost of care. Am J Med. 1982;73:381-384.
17. 18. Yassa L, Cibas ES, Benson CB, et al. Long-term assessment of a multidisciplinary approach to thyroid nodule diagnostic evaluation. Cancer. 2007;111:508-516.
18. 19. Haugen BR, Alexander EK, Bible KC, et al. 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the american thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26:1-133.
19. 20. Goldstein RE, Netterville JL, Burkey B, et al. Implications of follicular neoplasms, atypia, and lesions suspicious for malignancy diagnosed by fineneedle aspiration of thyroid nodules. Ann Surg. 2002;235:656-662.
20. 21. Ersöz C, Firat P, Uguz A, et al. Fine-needle aspiration cytology of solitary thyroid nodules: how far can we go in rendering differential cytologic diagnoses? Cancer. 2004;102:302-307.
21. 22. Salmaslioğlu A, Erbil Y, Dural C, et al. Predictive value of sonographic features in preoperative evaluation of malignant thyroid nodules in a multinodular goiter. World J Surg. 2008;32:1948-1954.
22. 23. Kocer D, Karakukcu C, Karaman H, et al. May the neutrophil/lymphocyte ratio be a predictor in the differentiation of different thyroid disorders? Asian Pac J Cancer Prev. 2015;16:3875-3879.
23. 24. Lang BH, Ng CP, Au KB, et al. Does preoperative neutrophil lymphocyte ratio predict risk of recurrence and occult central nodal metastasis in papillary thyroid carcinoma? World J Surg. 2014;38:2605-2612.
24. 25. Kim SM, Kim EH, Kim BH, et al. Association of the Preoperative Neutrophilto- ymphocyte Count Ratio and Platelet-to-Lymphocyte Count Ratio with Clinicopathological Characteristics in Patients with Papillary Thyroid Cancer. Endocrinol Metab (Seoul). 2015;30:494-501.
25. 26. Manatakis DK, Tseleni-Balafouta S, Balalis D, et al. Association of Baseline Neutrophil-to-Lymphocyte Ratio with Clinicopathological Characteristics of Papillary Thyroid Carcinoma. Int J Endocrinol. 2017;2017:8471235.
26. 27. Gong W, Yang S, Yang X, et al. Blood preoperative neutrophil-to-lymphocyte ratio is correlated with TNM stage in patients with papillary thyroid cancer. Clinics (Sao Paulo). 2016;71:311-314.
27. 28. Templeton AJ, McNamara MG, Seruga B, et al. Prognostic role of neutrophilto- lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst. 2014;106:124.
28. 29. Liu JF, Ba L, Lv H, et al. Association between neutrophil-to-lymphocyte ratio and differentiated thyroid cancer: a meta-analysis. Sci Rep. 2016;6:38551.
29. 30. Soyder A, Ünübol M, Şen O, Özbaş S, et al. The predictive value of the clinical features of malignancy in cases of preoperative follicular thyroid neoplasia. Minerva Chir. 2012;67:475-480.
30. 31. Cho JS, Park MH, Ryu YJ, et al. The neutrophil to lymphocyte ratio can discriminate anaplastic thyroid cancer against poorly or well differentiated cancer. Ann Surg Treat Res. 2015;88:187-192.
31. 32. Kisucka J, Butterfield CE, Duda DG, et al. Platelets and platelet adhesion support angiogenesis while preventing excessive hemorrhage. Proc Natl Acad Sci U S A. 2006;103:855-860.
32. 33. Sierko E, Wojtukiewicz MZ. Platelets and angiogenesis in malignancy. Semin Thromb Hemost. 2004;30:95-108.
33. 34. Tuncel T, Ozgun A, Emirzeoglu L, et al. Mean platelet volume as a prognostic marker in metastatic colorectal cancer patients treated with bevacizumabcombined chemotherapy. Asian Pac J Cancer Prev. 2014;15:6421-3.
34. 35. Mutlu H, Berk V, Karaca H, et al. Treatment regimen with bevacizumab decreases mean platelet volume in patients with metastatic colon cancer. Clin Appl Thromb Hemost. 2012;18:546-68.
35. 36. Krajewska J, Jarzab B. Novel therapies for thyroid cancer. Expert Opin Pharmacother. 2014;15:2641-52.
36. 37. Lian L, Xia YY, Zhou C, et al. Mean platelet volume predicts chemotherapy response and prognosis in patients with unresectable gastric cancer. Oncol Lett, 2015;10:3419-3424.
37. 38. Kılınçalp S, Ekiz F, Başar O, et al. Mean platelet volume could be possible biomarker in early diagnosis and monitoring of gastric cancer. Platelets. 2014;25:592-594.
38. 39. Gu M, Zhai Z, Huang L, et al. Pre-treatment mean platelet volume associates with worse clinicopathologic features and prognosis of patients with invasive breast cancer. Breast Cancer. 2016;23:752-760.
39. 40. Eryilmaz A, Basal Y, Omurlu IK. Can Head and Neck Cancers Be Detected with Mean Platelet Volume? Asian Pac J Cancer Prev. 2015;16:7045-7047.
40. 41. Kumagai S, Tokuno J, Ueda Y, et al. Prognostic significance of preoperative mean platelet volume in resected non-small-cell lung cancer. Mol Clin Oncol. 2015;3:197-201.
41. 42. Aksoy S, Kilickap S, Hayran M, et al. Platelet size has diagnostic predictive value for bone marrow metastasis in patients with solid tumors. Int J Lab Hematol. 2008;30:214-219.
42. 43. Oncel M, Kiyici A, Oncel M, et al. Evaluation of Platelet Indices in Lung Cancer Patients. Asian Pac J Cancer Prev. 2015;16:7599-7602.
43. 44. Dincel O, Bayraktar C. Evaluation of platelet indices as a useful marker in papillary thyroid carcinoma. Bratisl Lek Listy. 2017;118:153-155.