Value of Preoperative Neutrophil-to-Lymphocyte Ratio in Predicting Thyroid Cancer in Intermediate Category Fine Needle Aspiration Pathology

Author(s): Yasar Ozdenkaya, Pelin Basim, Naciye Cigdem Arslan

Context: The management of thyroid nodules with intermediate category of the Bethesda System for Reporting Thyroid Cancer (TBSRTC) is still debatable.

Objective: To investigate the diagnostic accuracy of neutrophil-tolymphocyte ratio (NLR) in detecting cancer in intermediate TBSRTC categories.

Design: Data of the patients who underwent thyroidectomy between 2012 and 2018 were analyzed retrospectively.

Subjects and Methods: Demographic characteristics, complete blood count, thyroid stimulating hormone (TSH) value, TBSRTC categories and postoperative pathology of the patients were collected. The association with preoperative NLR and postoperative pathology was assessed.

Results: Of 146 patients included in the study, 57 (39%) were in TBSRTC III, IV and V category. The mean NLR in this subgroup was 2.1±0.8 and similar between TBSRTC III, IV and IV groups (p=0.737). Thyroid cancer was detected in 38 (66.7%) patients. The mean NLR was 2.4±0.8 in thyroid cancers and significantly higher when compared with patients with benign postoperative pathology (1.6±0.4, p=0.014). There was a significant difference between papillary and follicular cancer; the mean NLR was 2.3±0.8 in papillary cancer and 2.6±0.7 in follicular cancer patients (p=0.005). The cut-off value of NLR for predicting cancer at 89% sensitivity and 53% specificity was 1.6 (Area under curve: 0.769, 95% confidence interval: 0.643-0.895, p=0.001).

Conclusion: Preoperative NLR is elevated in patients with thyroid cancer in intermediate TBSRTC categories. Despite low diagnostic accuracy, considering its availability and low costs, NLR has merit for further studies.