Assessment Of Differential Significance Of Preoperative NLR Combined With SII In Benign And Malignant Thyroid Nodules

Objectives:1.This study explored the diagnostic value of NLR combined with SII index in thyroid nodule,aiming to apply a simple and easily obtained inflammatory index for clinical practice and provide some valuable reference for the differential diagnosis of benign and malignant thyroid nodule2.By analyzing the risk factors of thyroid cancer and the correlation between NLR and SII and the pathological features of thyroid nodules,this study aims to provide some individualized risk assessment for patients with thyroid nodules,provide auxiliary reference advice for normal people's health screening,and reasonably avoid the risk of thyroid cancer.Methods:The clinicopathological data of 323 patients with thyroid nodules treated in the Department of head and neck surgery of Yunnan Cancer Hospital from May 2018 to July 2018 and the clinical physical examination data of 259 healthy subjects were collected retrospectively,according to the inclusion and exclusion criteria,at the same time,in order to avoid the difference in sample size to interfere with the results of the study,Finally,122 patients with thyroid papillary carcinoma(malignant group),122 patients with nodular goiter(benign group)and 122 patients with normal physical examination(normal group)were included in this study.SPSS 22.0 univariate and multivariate Logistic regression analysis were used to screen the risk factors,and draw the curves of neutrophil-lymphocyte ratio(neutrophil-to-lymphocyte ratio,NLR),systemic immune inflammatory index(systemic immune-inflammation index,SII)),platelet-lymphocyte ratio(plat el et-to-lymphocy te ratio,PLR)and lymphocyte-monocyte ratio(lymphocyte-to-monocyte ratio,LMR)(receiver operating characteristic,ROC.Calculate NLR combined with SII index to predict the analysis curve and the area under the curve((Area Under Curve,AUC),and compare the effect of each index in the differential diagnosis of benign and malignant thyroid nodules.Med Calc software calculates the best cut-off value of NLR combined with SII index to distinguish between benign and malignant thyroid nodules(when Jordan index is the highest).The relationship between different NLR+SII groups and clinicopathological features of thyroid nodules was analyzed.Results:1.The differences in gender,leukocyte,lymphocyte,absolute value of neutrophil count,platelet,NLR,SII,PLR,LMR,Tg-Ab,TPO-Ab and FT3 between the normal group and the malignant group were statistically significant(all P<0.05).The differences in age,monocytes,absolute values of red blood cell count,TSH,Tg and FT4 were not statistically significant(all P>0.05).2.There were statistically significant differences between the benign group and the malignant group in age,leukocyte,lymphocyte,monocytes,absolute value of neutrophil count,NLR,SII,PLR,LMR,Tg,Tg-Ab,primary tumor size and tumor site(all P<0.05).The differences in gender,erythrocyte,absolute value of platelet count,TSH,TPO-Ab,FT3 and FT4 were not statistically significant(all P>0.05).3.According to multivariate Logistic regression analysis,age,NLR and primary tumor size were all independent risk factors for thyroid papillary carcinoma.4.Area under NLR+SII curve>area under NLR curve>SII curve area under>PLR curve>LMR curve,area under NLR ROC curve is 0.787(95%CI(0.730,0.843)),area under NLR+SII ROC curve is 0.792(95%CI(0.736,0.848)).5.The best cut-off value of NLR+SII for differential diagnosis of benign and malignant nodules was 0.37533,the sensitivity was 89.34%,the specificity was 58.20%,the positive predictive value was 68.10%,the negative predictive value was 84.50%,the positive likelihood ratio was 2.14,and the negative likelihood ratio was 0.18.6.There were significant differences in age,tumor size,tumor location and Tg-Ab between the high NLR+SII group and the low NLR+SII group(all P<0.05),but there was no significant difference in sex,tumor location,Hashimoto and TPO-Ab between the two groups(all P>0.05).Conclusions:1.Female,38 to 51 years old,the location of the tumor was located on the left,The maximum diameter of the primary tumor was>1cm,High NLR values,High Tg-Ab is a risk factor for malignant thyroid nodule.2.The diagnostic efficacy of NLR combined with SII was significantly better than that of NLR,SII,PLR and LMR.3.NLR+SII>0.37533 was more accurate in predicting thyroid cancer.4.NLR combined with SII index can assist in differentiating benign and malignant thyroid nodules,assist in disease screening in healthy people,and provide individualized risk assessment for patients with thyroid nodules.