Evaluation of Serum Neutrophil to Lymphocyte Ratio in The Results of Thyroid Fine Needle Aspiration: Can It Discriminate A Clinical Benefit for the Atypia of Undetermined Significance?

Year 2021, , 188 - 194, 29.10.2021

Özlem Özdemir , Hamza Çınar , Çağrı Akalın , Mürüvvet Akçay Çelik

https://doi.org/10.46310/tjim.898205

Abstract

Introduction: Thyroid biopsy results are evaluated according to The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) worldwide. The most ambiguous result from these categories is the Bethesda-III which is defined as “atypia of undetermined significance” (AUS). Neutrophil to lymphocyte ratio (NLR) is still evaluated in thyroid disorders and malignancy. The purpose of this study was to evaluate the NLR results in Bethesda Categories and whether the NLR can discriminate a clinical benefit for the AUS category.
Methods: In this retrospective study, 1771 patients who had fine needle aspiration biopsy(FNAB) were examined. Demographic characteristics, NLR, Bethesda scores, operation rates and postoperative histopathological results were recorded.
Results: The categories were; Bethesda-I for 298(16,8%), Bethesda-II for 1320(74,5%), Bethesda-III for 60(3,4%), Bethesda-IV for 27(1,5%), Bethesda-V for 36(2%), Bethesda-VI for 30(1,7%) results respectively. The mean NLR was 2,68. There was no statistically significant difference between groups in terms of NLR(p=0.250). Overall, 226 (12,76%) patients were undergoing thyroidectomy. The AUS group was founded by 3.4%, operation rate was 21,66% and malignancy rate was 23,07%. There was a statistically significant difference between Bethesda scores and malignancy rates(p<0.001). There was no statistically significant difference between the postoperative results in terms of NLR(p=0,973).
Conclusion: The NLR does not differ according to the Bethesda Categories neither the postoperative histopathological results. It is not a predictive parameter for the benign or malignant differentiation. We think that NLR cannot discriminate a clinical benefit for the surgery decision in the follow-up of the AUS category.

Keywords

Neutrophil to lymphocyte ratio, Bethesda Categories, Fine needle aspiration biopsy, Atypia of undetermined significance, Thyroid malignancy

References

• Guth S, Theune U, Aberle J, Galach A, Bamberger CM.. Very high prevalence of thyroid nodules detected by high frequency (13 MHz) ultrasound examination. Eur J Clin Invest. 2009;39:699–706.
• Cibas ES1, Ali SZ2. Bethesda system for reporting thyroid cytopathology. Thyroid. 2017 Nov;27(11):1341-1346.
• Balkwill F, Mantovani A. Inflammation and cancer: back to Virchow? Lancet. 2001;357:539–545.
• Moore MM, Chua W, Charles KA, Clarke SJ. Inflammation and Cancer: Causes and Consequences.Clinical Pharmacology & Therapeutics. 2010; 87 4; 504–508.
• Diakos CI, Charles KA, McMillan DC, Clarke SJ. Cancer-related inflammation and treatment effectiveness. Lancet Oncol. 2014;15:e493–e503.
• Walsh SR, Cook EJ, Goulder F, Justin TA, Keeling NJ. Neutrophil-lymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol. 2005;91:181–184.
• Bhatti I, Peacock O,Lloyd G, Larvin M, Hall R.I. Preoperative hematologic markers as independent predictors of prognosis in resected pancreatic ductal adenocarcinoma: neutrophil-lymphocyte versus platelet-lymphocyte ratio.Am J Surg. 2010 Aug;200(2):197-203.
• Naohiko N, Shinichi K, Yoritaka F, Seiko M, Jun F, Daisuke K, Yasuto T, Takashi M, Hideto F, Nobuhiko U, Yasuo I, Takeo K. The neutrophil/lymphocyte ratio as a predictor of peritoneal metastasis during staging laparoscopy for advanced gastric cancer: a retrospective cohort analysis. World J Surg Oncol. 2019; 17: 108. doi: 10.1186/s12957-019-1651-1653
• Kocer D, Karakukcu C, Karaman H, Gokay F, Bayram F. May the Neutrophil/Lymphocyte Ratio Be a Predictor in the Differentiation of Different Thyroid Disorders? Asian pacific journal of cancer prevention, 2015;16(9):3875-3879.
• Çadirci K, Yıldız F, Keskin H, Bayrak M, Özmen H.K, Durmaz A.Ş, Çarlioğlu A. Investigation of the neutrophil/lymphocyte and monocyte to high-density lipoprotein cholesterol ratios in differentiated thyroid cancers. J Health Sci Med 2020; 3(2): 172-175
• Sit M, Aktas G, Erkol H, Yaman S, Keyif F, Savli H. Neutrophil to Lymphocyte Ratio Is Useful in Differentiation of Malign and Benign Thyroid Nodules. P R Health Sci J. 2019 Mar;38(1):60-63.
• Yaylacı S, Tosun O, Sahin O, Genc AB, Aydın E, Demiral G et al. Lack of Variation in Inflammatory Hematological Parameters between Benign Nodular Goiter and Papillary Thyroid Cancer. Asian pacific journal of cancer prevention, 2016 Vol 17.4.2321.
• Liu JF, Ba L, Lv H, Lv D, Du JT, Jing XM et al. Association between neutrophil-to-lymphocyte ratio and differentiated thyroid cancer: a meta-analysis. Sci Rep. 2016 Dec 12;6:38551.
• Johnny Ling , Wencheng Li , Neeraj Lalwani. Atypia of undetermined significance/follicular lesions of undetermined significance: What radiologists need to know. Neuroradiol J. 2020 Dec 28;1971400920983566. doi: 10.1177/1971400920983566.
• Garg S, Naik LP, Kothari KS, et al. Evaluation of thyroid nodules classified as Bethesda category III on FNAC. J Cytol 2017; 34: 5–9.
• Sullivan PS, Hirschowitz SL, Fung PC, et al. The impact of atypia/follicular lesion of undetermined significance and repeat fine-needle aspiration: 5 years before and after implementation of the Bethesda System. Cancer Cytopathol 2014; 122: 866–872.
• Erivwo P, Ghosh C. Atypia of undetermined significance in thyroid fine-needle aspirations: Follow-Up and Outcome Experience in Newfoundland, Canada. Acta Cytol. 2018;62(2):85-92
• Ryu YJ, Jung YS, Yoon HC, Hwang MJ, Shin SH, Cho JS. et al. Atypia of undetermined significance on thyroid fine needle aspiration: surgical outcome and risk factors for malignancy. Ann Surg Treat Res. 2014;86(109)
• Mileva M, Stoilovska B,Jovanovska A, Ugrinska A, Petrushevska G, Kostadinova S et al. Thyroid cancer detection rate and associated risk factors in patients with thyroid nodules classified as bethesda category III Radiol Oncol. 2018 Dec; 52(4): 370–376.
• Bayır Ö, Karagöz T, Öcal B, Çakal E, Saylam G, Korkmaz M.H. Predictive role of neutrophil-lymphocyte and platelet-lymphocyte ratios in thyroid nodules with cytological diagnosis of “undetermined significance” and “suspicious for malignancy”. ENT Updates 2017;7(1):28–32. doi:10.2399/jmu.2017001003
• Remonti LR, Kramer CK, Leitao CB, Pinto LCF, Gross JL.. Thyroid ultrasound features and risk of carcinoma: a systematic review and meta-analysis of observational studies. Thyroid. 2015;25:538–550.
• Eroglu A.H, Karayol S.S, Guvendic B, Adalid Y. Predictive value of inflammatory cell ratios in incidental thyroid papillary carcinoma Fam Pract Palliat Care. 2019 Dec;4(3):85-88
• Ari A, and Gunver F. Comparison of neutrophil–lymphocyte ratio and platelet–lymphocyte ratio in patients with thyroiditis and papillary tumors. J Int Med Res. 2019 May; 47(5): 2077–2083. doi: 10.1177/0300060519838392