DİFERANSİYE TİROİD KANSERLİ HASTALARDA PREOPERATİF NÖTROFİL / LENFOSİT ORANININ BOYUN ULTRASONOGRAFİSİ VE PATOLOJİK BULGULARLA İLİŞKİSİ

AMAÇ: Nötrofil lenfosit oranı (NLO) oksidatif stresin ve sistemik enflamasyonun güçlü bir belirtecidir. Bu çalışma ile; diferansiye tiroid kanseri tanısı ile opere olan hastaların patolojik bulgularının ve ultrasonda (USG) saptanan lenf nodu özelliklerinin preoperatif dönemde bakılan NLO ile karşılaştırılması amaçlanmıştır. GEREÇ VE YÖNTEM: 2012 - 2020 yılları arasında Genel Cerrahi Kliniği’nde diferansiye tiroid kanseri tanısı ile opere olan hastaların demogrofik özellikleri, preoperatif boyun USG’ si ve patoloji sonuçları kayıt edildi. Preoperatif rutin kan testlerindeki nötrofil sayısının lenfosit sayısına bölünmesiyle NLO elde edildi. Receiver Operating Curve (ROC) analizi ile NLO için cut - off değeri hesaplanarak diğer parametreler ile karşılaştırıldı. BULGULAR: Çalışmamıza 105 hasta dahil edilmiştir. Hastaların %71,4’ü kadındır. Yaş ortalaması 47,9 ± 14,1’dir. Preoperatif yapılan boyun USG’ de %63,8’ inde boyunda lenf nodu tespit edilmedi. Ameliyat sonrası %94,3’ ü papiller karsinom tanısı aldı. Tümör çapı % 30,5’ inde 2-4 cm (T2) idi. Hastaların %74,3’ünün patoloji raporunda metastatik lenf nodu saptanmadı ve %63,8’ inde kapsül invazyonu yoktu. Cerrahi sınırlar %90,5’ inde negatifdi. Tümör %38,6’ sında multifokal ve %23,8’ inde ise bilateral yerleşimliydi. Cut-off değeri NLO için 2,16 olarak hesaplandı. Tiroid kanserlerinde NLO; erkek cinsiyette (p = 0,027), USG’de lenf nodu metastazı şüphesi olanlarda (p = 0,001) ve patolojide lenf nodu metastazı saptananlarda (p < 0,001) anlamlı olarak daha yüksekti. Diğer parametrelerde anlamlı fark izlenmedi. SONUÇ: Tiroid kanserli hastalarda yüksek NLO değerlerinde boyun lenf nodu metastazı gelişiminin artması nedeni ile NLO’ nun prognostik gösterge olarak kullanımının akılda tutulmasını öneriyoruz.

THE CORRELATION OF PREOPERATIVE NEUTROPHIL / LYMPHOCYTE RATIO WITH NECK ULTRASONOGRAPHY AND PATHOLOGICAL FINDINGS IN PATIENTS WITH DIFFERENTIATED THYROID CANCER

AIM: Neutrophil-lymphocyte ratio (NLR) is a strong biomarker of oxidative stress and systemic inflammation. The aim of this study is to compare NLR with lymph node features detected in ultrasonography (US) and histopathologic examination results of patients operated with diagnosis of differentiated thyroid cancer. MATERIAL AND METHOD: Demographic characteristics, preoperative neck US and pathology results of patients were operated with the diagnosis of differentiated thyroid cancer were recorded in the General Surgery Clinic between 2012 – 2020. NLR was calculated by dividing the neutrophil count by the lymphocyte count in preoperative routine blood tests. The cut-off value for the NLR was calculated with Receiver Operating Curve (ROC) analysis and compared with other parameters. RESULTS: A total of 105 patients were included in our study. The rate of female patients is 74%. The average age is 47.9 ± 14.1. No lymph node was found in 63.8% of the patients on preoperatively neck US. In the postoperative histopathologic examination results, 94.3% of the patients were diagnosed with papillary carcinoma. Tumor diameter was 2-4 cm (T2) in 30.5%. No metastatic lymph node was found in 74.3%. There was no capsule invasion in 63.8%. Surgical margins were free in 90.5%. The tumor was located multifocal in 38.6% and bilaterally in 23.8%. The cut-off for NLR was calculated as 2.16. NLR was significantly higher in thyroid carcinomas with male gender (p = 0,027), suspected lymph node metastasis on US (p = 0,001) and lymph node metastasis detected in histopathologic examination. (p

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