Application Of Neutrophil/Lymphocyte Ratio In Preoperative Diagnosis Of Sinonasal Inverted Papilloma And Its Malignant Transformation

Objective:Sinonasal inverted papilloma(SNIP)is a common benign tumor of the nose.SNIP has the characteristics of easy recurrence,easy to malignant transformation and invasion and destruction of adjacent tissue structure,so it is a borderline tumor.Clinically,SNIP lack of specific symptoms and signs,can also be associated with sinusitis,nasal polyps,and present there is still a lack of satisfactory preoperative diagnostic criteria for SNIP associated with malignant transformation,which can lead to misdiagnosis and delayed treatment.It is known that malignant tumors can cause systemic and local inflammatory responses,which can lead to the changes of peripheral blood cell components especially neutrophil/lymphocyte ratio(NLR).The aim of this study was to analyze the changes of the peripheral blood cell composition of SNIP and its malignant transformation.Objective to investigate the value of NLR in preoperative diagnosis of SNIP and its malignant transformation.Methods:49 patients with SNIP diagnosed by postoperative pathology from January 2010 to December 2016 in Department of Otolaryngology Head and Neck Surgery of the Shanxi Medical University Hospital were selected,including 35 males and 14 females.According to whether with malignant transformation patients were divided into two groups.There were 9 cases of SNIP with malignant transformation group(group A),including 6 males and 3 females,the mean age is 50�13 years old.There were 40 cases of SNIP group(group B),including 29 male and 11 female,the mean age is 54�15 years old.In the same period in our department,30 patients with chronic sinusitis and nasal polyps diagnosed by postoperative pathology were selected as the C group,including 17 male and 13 female,the mean age is 31�11 years old.Then in the same period in our hospital select 30 healthyadults of health examination center as the healthy control group(group D),including 16 male and 14 female,the mean age is 43�7 years old.The clinical data of each group were retrospectively analyzed.By analyzing the number of preoperative peripheral blood cell count and NLR,to explore the value of each value in the preoperative diagnosis of SNIP and its malignant transformation.Results:1.There was no significant difference in the four groups in white blood cell count,neutrophil count,basophil count,platelet count,monocyte count(P>0.05).The lymphocyte count in the SNIP with malignant transformation group(1.86 � 0.31)was significantly lower than that in the SNIP group(2.26�0.42),the chronic sinusitis with nasal polyps group(2.39�0.41)and the healthy control group(2.32�0.40)(P<0.05).NLR in the SNIP with malignant transformation group(1.97�0.22)was significantly higher than that in the SNIP group(1.42�0.25),the chronic sinusitis with nasal polyps group(1.35�0.16)and the healthy control group(1.37 � 0.17)(P<0.05).The eosinophil count in the chronic sinusitis and nasal polyps group(0.26 � 0.13)was significantly higher than that in the SNIP with malignant transformation group(0.15�0.09),the SNIP group(0.16�0.10)and the healthy control group(0.16�0.10)(P<0.05).2.Related analysis found that lymphocyte count was negatively correlated with SNIP with malignant transformation(r=-0.363,P=0.01).Neutrophil count was positively correlated with SNIP with malignant transformation(r=0.339,P=0.017).NLR was positively correlated with SNIP with malignant transformation(r=0.585,P < 0.01).3.Logistic regression analysis found that the decrease of lymphocyte count(P=0.018),the increase of neutrophil count(P= 0.044)and the elevation of NLR(P=0.002)were all risk factors of SNIP with malignant transformation.4.ROC curve showed that the lymphocyte count,the neutrophil count and NLR had diagnostic value for SNIP with malignant transformation(area under the curve respectively were 0.771,0.753,0.936).Because the area under the curve of NLR was the largest,NLR had the highest diagnostic value in SNIP with malignant transformation.When the value of NLR is 1.71,the sensitivity and specificity of differential diagnosis of SNIP and SNIP with malignant transformation were relatively high,the sensitivity was88.9% and the specificity was about 75%.Conclusion:The neutrophils/lymphocytes ratio is positively related to sinonasal inverted papilloma with malignant transformation.It can be used as a predictor of malignant change before operation.The ratio of 1.71 can be used as a defined reference value for differential diagnosis of SNIP with malignant transformation.