Thyroid Cancer Clinical Trial
Official title:
Delta Neutrophil Index and Neutrophil Lymphocyte Ratio in Differentiation of Thyroid Malignancy and Nodular Goiter
Thyroid surgery is the most common surgical procedure among endocrine surgeries. It is
performed in patients with suspected malignancy, patients diagnosed with malignancy, and for
toxic nodular goiter [1]. Fine-needle aspiration biopsy (FNAB) is used as a daily technique
in preoperative evaluation to differentiate malignant and benign nodules. However,
complications including hematoma formation, tumor transplantation along the needle trace,
thyroid nodule infarction and vascular proliferation can be seen even in this minimally
invasive procedure [2]. Therefore, the differentiation of benign and malignant groups using
non-interventional methods before surgery has become important.
Cancer-related inflammation, including papillary thyroid carcinoma, is involved in
carcinogenesis and progression of neoplastic disease [3,4]. Neutrophils induced by the tumor
can accelerate tumor metastasis [3,5]. Lymphocytes, as the cornerstone of the adaptive immune
system, inhibit tumor cell proliferation and migration as well as destroying metastases
[3,6]. Previous studies have shown that increased lymphocyte count has a positive effect on
better survival in patients with advanced cancer [7]. Furthermore, Kupffer cells, also known
as liver macrophages, destroy circulating cancer cells and help the distribution of tumor
cells via circulation. Therefore, routine blood tests have been investigated as a predictive
or prognostic factor for carcinomas since blood parameters in these tests show whether there
is inflammation. Neutrophil count, lymphocyte count, neutrophil-lymphocyte ratio (NLR),
lymphocyte-monocyte ratio (LMR), mean platelet volume (MPV), and platelet distribution width
(PDW) have been studied in terms of numerous malignancies [3].
Tumor-related inflammation is activated the bone marrow and inflammation induced by
malignancies. Inflammatory activity that is poorly controlled or uncontrollable may be
responsible for malignant transformation [8]. At this point, NLR has previously been shown to
be useful in the differentiation of thyroid malignancies and benign thyroid diseases [9].
Delta neutrophil index (DNI) / increased number of immature granulocytes (IG) represents
active bone marrow. Delta neutrophil index, which is manifested by IG formation in
inflammatory and infectious events, shows changes in the white blood cell count [10].
This study aimed to evaluate the relation between the automatically calculated DNI/IG count
and manually calculated NLR from the preoperative complete blood count (CB) parameters, and
thyroid malignancies with a cost-effective non-invasive method before surgery or biopsy as
the indicator of the malignant inflammatory response in the differentiation of nodular goiter
and thyroid malignancy.
Material-Methods Patients over the age of 18 who underwent thyroid surgery and who were
operated on non-malignant benign causes (inguinal hernia) under selective conditions without
any thyroid disease between November 2014 and November 2019 in Kahramanmaraş Sütçü İmam
University Department of General Surgery were evaluated in this retrospective case-control
cohort study. Patients in the thyroid pathology group (Group T) were divided into two
subgroups according to their pathologic results: malignant (Group M) and benign thyroid
disorders (Group B). Patients operated for inguinal hernia, were selected as control group
(Group C).
All procedures performed in studies involving human participants were in accordance with the
ethical standards of the institutional and/or national research committee and with the 1964
Helsinki declaration and its later amendments or comparable ethical standards.
Preoperative biopsy results of patients undergoing FNAB in the preoperative period were
investigated according to the Bethesda Classification System [11]. Neutrophil - lymphocyte
count in the routine complete blood count (CBC) values, which were measured in the
preoperative period and the postoperative sixth-month follow-ups, were recorded
retrospectively and calculated manually. DNI (IG percentage) and IG counts were recorded from
the values measured automatically in the CBC performed in the preoperative period and the
postoperative sixth-month. Patient data were obtained from patient epicrisis forms and
preoperative laboratory and postoperative pathology results recorded in the computer system.
Statistical Analysis The power analysis of the study was conducted with G-Power 3.0.10
programming system. Estimated power analysis and the sample size with an 0.8 power and effect
size 0.1 according to three groups evaluation for 2 repeated measures in need of total 246
samples.
Statistical analysis was performed using IBM Social Package for the Social Sciences (SPSS)
version 20 software. In the evaluation of independent groups, Kolmogorov-Smirnov and
Shapiro-Wilk tests were used to determine if the distrubiton of variables were normal or not.
Student t-test or Mann-Whitney U test was used to evaluate the numerical data between Group C
and Group T. ANOVA or Kruskal Wallis test was used to evaluate numerical data for subgroup
relations with Group C. Chi-square test or Fischer's exact test was used to evaluate
categorical data. The repeated-measures ANOVA was used to evaluate the differences between
the preoperative and postoperative periods. The data were evaluated using Posthoc Tukey's B
test following the variance analysis. Sensitivity and specificity values and cut-off values
were obtained via the receiver operating characteristic (ROC) analysis to evaluate the
effectiveness of NLR, IG count, and DNI.
Numerical data were expressed as mean ± standard deviation (minimum-maximum values) or median
(minimum-maximum values) according to the normal distribution. Categorical values were
expressed as percentages (%).
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