Faculty of Medicine, Department of Surgery, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey.
Faculty of Medicine, Department of Anesthesiology and Reanimation, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey.
World J Surg. 2021 Feb;45(2):507-514. doi: 10.1007/s00268-020-05822-6. Epub 2020 Oct 16.
It was aimed to evaluate the relationship between delta neutrophil index (DNI) and neutrophil-to-lymphocyte ratio (NLR) in the preoperative differentiation of nodular goiter and thyroid malignancy.
Patients over the age of 18 who underwent thyroid surgery between November 2014 and November 2019 were evaluated in this retrospective cohort study. Patients were divided into two groups according to their pathology results: malignant (Group M) and benign (Group B) thyroid disorders. White blood cell (WBC) count, neutrophil count, lymphocyte count, IG count and DNI were measured using an automated hematological analyzer from blood samples obtained at the preoperative period and postoperative 6th month of the follow-up. Neutrophil-to-lymphocyte ratio (NLR) values were manually calculated. Numerical data are expressed as means ± standard deviations (minimum-maximum values) or medians (minimum-maximum values) according to the normal distribution. Categorical values are expressed as percentages (%).
A total of 243 patients (190 patients in Group B and 53 patients in Group M) who met the inclusion criteria were evaluated. The male/female ratio was 49/194. A statistically significant difference between Group M and Group B in terms of preoperative NLR, DNI and IG count was observed (p = 0.001, < 0.001 and < 0.001, respectively). No statistically significant difference was observed between the groups in terms of the control values performed in the postoperative period in terms of the NLR, DNI and IG count (p = 0.711, 0.333 and 0.714, respectively). A significant decrease was observed in the preoperative and postoperative DNIs, IG counts and NLRs in Group M (p = 0.009, < 0.001 and < 0.001, respectively). For the diagnosis of malignant thyroid diseases, the cut-off value of DNIs was ≥0.35%, and DNI sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 79.2%, 78.9%, 79.2% and 77.9%, respectively (area under the curve [AUC]: 0.847; confidence interval [CI]: 0.784-0.911). The cut-off value of the IG count was ≥25/mm, and its sensitivity, specificity, PPV and NPV were 83%, 72.1%, 83%, and 72.1%, respectively (AUC: 0.847; CI: 0.784-0.911).
DNI and IG counts are cheap and easily accessible tests that can be automatically calculated from automated systems without additional cost in differentiation of thyroid malignancies from benign disorders in the preoperative period.
本研究旨在评估术前中性粒细胞与淋巴细胞比值（NLR）和中性粒细胞-淋巴细胞比值（DNI）在结节性甲状腺肿和甲状腺恶性肿瘤鉴别诊断中的关系。
本回顾性队列研究纳入 2014 年 11 月至 2019 年 11 月期间接受甲状腺手术的年龄大于 18 岁的患者。根据病理结果将患者分为两组：恶性（M 组）和良性（B 组）甲状腺疾病。使用全自动血细胞分析仪检测术前和术后 6 个月的白细胞（WBC）计数、中性粒细胞计数、淋巴细胞计数、IG 计数和 DNI。手动计算 NLR 值。根据正态分布，数值数据表示为均值±标准差（最小值-最大值）或中位数（最小值-最大值）。分类值表示为百分比（%）。
共评估了 243 名符合纳入标准的患者（B 组 190 名，M 组 53 名）。男性/女性比例为 49/194。M 组与 B 组在术前 NLR、DNI 和 IG 计数方面存在显著差异（p=0.001、<0.001 和<0.001）。在术后 NLR、DNI 和 IG 计数的对照组中，两组间无统计学差异（p=0.711、0.333 和 0.714）。M 组的术前和术后 DNI、IG 计数和 NLR 均显著下降（p=0.009、<0.001 和<0.001）。对于恶性甲状腺疾病的诊断，DNI 的截断值为≥0.35%，DNI 的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为 79.2%、78.9%、79.2%和 77.9%（曲线下面积[AUC]：0.847；置信区间[CI]：0.784-0.911）。IG 计数的截断值为≥25/mm，其敏感性、特异性、PPV 和 NPV 分别为 83%、72.1%、83%和 72.1%（AUC：0.847；CI：0.784-0.911）。
DNI 和 IG 计数是一种廉价且易于获取的检测方法，无需额外费用，可通过自动化系统自动计算，有助于术前鉴别甲状腺良恶性疾病。
