Atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) is a heterogeneous that cannot be definitively diagnosed as benign, malignancy-suspect, or malignant. This study was conducted to evaluate the ability of mean platelet volume (MPV) and neutrophil-to-lymphocyte ratio (NLR) to predict the malignant potential of nodules diagnosed as AUS/FLUS. We retrospectively analyzed 101 patients for whom thyroid fine needle aspiration biopsy (FNAB) analysis indicated AUS/FLUS and who underwent surgery between 2011 and 2015. Demographic, laboratory, and histopathological data were obtained from a database. The patients were categorized into two groups: malignant or benign and comparisons between groups were performed. Of the 101 patients, 26 (25.7%) had solitary nodules and 75 (74.3%) had multinodulary goiter. The malignancy rate was 33.7%, and there were no differences between the two groups in terms of age, gender and thyroid function tests. Median preoperative red cell distribution width (RDW) level was 13.4 in the benign group, while it was 14.4 in patients with malignancy, demonstrating a significant correlation. Both MPV and NLR were elevated in malignant nodules. The malignancy risk of AUS/FLUS evident upon thyroid FNAB was higher than anticipated by the Bethesda system (BS). MPV, NLR and RDW are useful for estimating the malignancy risks of these diseases.
___
Yassa L, Cibas ES, Benson CB, et al. Long-term assessment of a multidisciplinary approach to thyroid nodule diagnostic evaluation. Cancer. 2007;111(6):508-16.
Cibas ES, Ali SZ. The Bethesda system for reporting thyroid cytopathology. Am J Clin Pathol. 2009;132(5):658-65.
Vanderlaan PA, Krane JF, Cibas ES. The frequency of ’atypia of undetermined significance’ interpretations for thyroid fine-needle aspirations is negatively correlated withundetermined significance’ interpretations for thyroid fineneedle aspirations is negatively correlated with histologically proven malignant outcomes. Acta Cytol. 2011;55(6):512-7.
Cochand-Priollet B, Schmitt FC, Tötsch M, et al. European Federation of Cytology Societies’ Scientific Committee. The Bethesda terminology for reporting thyroid cytopathology: from theory to practice in Europe. Acta Cytol. 2011;55(6):507-11.
Nayar R, Ivanovic M. The indeterminate thyroid fineneedle aspiration: experience from an academic center using terminology similar to that proposed in the 2007 National Cancer Institute Thyroid Fine Needle Aspiration State of the Science Conference. Cancer. 2009;117(3):195-202.
Theoharis CG, Schofield KM, Hammers L, et al. The Bethesda thyroid fineneedle aspiration classification system: year 1 at an academic institution. Thyroid. 2009;19(11):1215-23.
Çuhaci N, Arpaci D, Üçler R, et al. Malignancy Rate of Thyroid Nodules Defined as Follicular Lesion of Undetermined Significance and Atypia of Undetermined Significance in Thyroid Cytopathology and Its Relation with Ultrasonographic Features. Endocr Pathol. 2014;25(3):248-56.
Nikiforov YE, Ohori NP, Hodak SP, et al. Impact of mutational testing on the diagnosis and management of patients with cytologically indeterminate thyroid nodules: a prospective analysis of 1056 FNA samples. J Clin Endocrinol Metab. 2011;96(11):3390-7.
Cochand-Priollet B, Dahan H, Laloi-Michelin M, et al. Immunocytochemistry with cytokeratin 19 and antihuman mesothelial cell antibody (HBME1) increases the diagnostic accuracy of thyroid fine-needle aspirations: preliminary report of 150 liquid-based fine-needle aspirations with histological control. Thyroid. 2011;21(10):1067-73.
Guarino V, Castellone MD, Avilla E, et al. Thyroid cancer and inflammation. Mol Cell Endocrinol. 2010;321(1):94-102.
Azab B, Bhatt VR, Phookan J, et al. Usefulness of the neutrophil-tolymphocyte ratio in predicting short- and long-term mortality in breast cancer patients. Ann Surg Oncol. 2012;19(1):217-24.
Kishi Y, Kopetz S, Chun YS, et al. Blood neutrophil-to-lymphocyte ratio predicts survival in patients with colorectal liver metastases treated with systemic chemotherapy. Ann Surg Oncol. 2009;16(3):614-22.
Wang S, Zhang Z, Fang F, et al. The neutrophil/lymphocyte ratio is an independent prognostic indicator in patients with bone metastasis. Oncol Lett. 2011;2(4):735-40.
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(6):691-6.
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(5):493-7.
Sierko E, Wojtukiewicz MZ. Platelets and angiogenesis in malignancy. Seminars in Thrombosis and Hemostasis. 2004;30(1):95-108.
Mangalpally KK, Siqueiros-Garcia A, Vaduganathan M, et al. Platelet activation patterns in platelet size subpopulations: differential responses to aspirin in vitro. J Thrombosis Thrombolysis. 2010;30(3):251-62.
Cho SY, Yang JJ, You E, et al. Mean platelet volume/ platelet count ratio in hepatocellular carcinoma. Platelets. 2013; 24(5):375-7.
Baldane S, Ipekci SH, Sozen M, et al. Mean Platelet Volume Could be a Possible Biomarker for Papillary Thyroid CarcinomasAsian Pac J Cancer Prev. 2015;16(7):2671-4.
Bayhan Z, Zeren S, Ozbay I, et al. Mean Platelet Volume as a Biomarker for Thyroid Carcinoma. Int Surg. 2016;101(1):50-3.
VanderLaan PA, Marqusee E, Krane JF. Clinical outcome for atypia of undetermined significance in thyroid fine-needle aspirations: should repeated FNA be the preferred initial approach? Am J Clin Pathol. 2011;135(5):770-5.
Somma J, Schlecht NF, Fink D, et al. Thyroid fine needle aspiration cytology: follicular lesions and the gray zone. Acta Cytol. 2010; 54(2):123-31.
Kayilioglu SI, Dinc T, Sozen I, et al. Thyroid nodules with atypia or follicular lesions of undetermined significance (AUS/FLUS): analysis of variables associated with outcome. Asian Pac J Cancer Prev. 2014;15(23):10307-11.
Gasparyan AY, Ayvazyan L, Mikhailidis DP, et al. Mean platelet volume: A link between thrombosis and inflammation? Curr Pharm Des. 2011;17(1):47-58.
Wang RT, Li Y, Zhu XY, et al. Increased mean platelet volume is associated with arterial stiffness. Platelets. 2011;22(6):447-51.
Shimada H, Takiguchi N, Kainuma O, et al. High preoperative neutrophillymphocyte ratio predicts poor survival in patients with gastric cancer. Gastric Cancer. 2010;13(3):170-6.
Wenger FA, Jacobi CA, Zieren J, et al. Tumor size and lymph-node status in pancreatic carcinomadis there a correlation to the preoperative immune function? Langenbecks Arch Surg. 1999;384(5):473-8.
Rashid F, Waraich N, Bhatti I, et al. A pre-operative elevated neutrophil: lymphocyte ratio does not predict survival from oesophageal cancer resection. World J Surg Oncol. 2010;6(8):1.
Sharaiha RZ, Halazun KJ, Mirza F, et al. Elevated preoperative neutrophil: lymphocyte ratio as a predictor of postoperative disease recurrence in esophageal cancer. Ann Surg Oncol. 2011;18(12):3362–9.
Beyazit Y, Kekilli M, Ibis M,et al. Can red cell distribution width help to discriminate benign from malignant biliary obstruction? A retrospective single center analysis. Hepatogastroenterology. 2012;59(117):1469-73.
Ford HC, Carter JM. The haematology of hyperthyroidism: abnormalities of erythrocytes, leucocytes, thrombocytes and haemostasis. Postgraduate Medical Journal. 1998;64(756):735-42.
Güneş F, Asik M, Altun B, ark. Aşikar ve subklinik hipotiroidili hastalarda karotis arter intima media kalınlığı ve nötrofil lenfosit oranı. Journal of Clinical and Experimental Investigations. 2013;4(4):463-7.
Ren X, Meng Z, Liu M, et al. No associations exist between mean platelet volume or platelet distribution width and thyroid function in Chinese. Medicine. 2016;95(40):e4573.
Franchini M, Montagnana M, Manzato F, et al. Thyroid dysfunction and hemostasis: an issue still unresolved. In Seminars in thrombosis and hemostasis. 2009;35(3):288-94.