Value Of Peripheral Blood NLR Levels Combined With TIRADS Grades In The Diagnosis Of Benign And Malignant Thyroid Nodules

Objective:Thyroid nodules are common clinical thyroid diseases.With the development of ultrasound technology,the formation of a standardized thyroid imaging report and data system(TIRADS)is of great value for the identification of benign and malignant thyroid nodules.Inflammation is closely related to the occurrence and development of tumors.The Neutrophil to lymphocyte ratio(NLR)is considered to be a new indicator of inflammatory response.It has been reported that there is a correlation between elevated NLR and tumors.This study aims to analyze changes in peripheral blood NLR levels and TIRADS grades of patients with thyroid nodules,and to explore the diagnostic value of peripheral blood NLR levels combined with TIRADS grades for benign and malignant thyroid nodules.Methods:Retrospective analysis of the case data of 780 patients undergoing thyroid nodule surgery for the first time from January 2017 to October 2019 in the Department of General Surgery,the First Affiliated Hospital of Nanchang University.All patients met the inclusion criteria,thyroid nodules were divided into two groups based on the pathological results of thyroid surgery: benign nodule group and malignant nodule group.Collecting patient gender,age,white blood cells,red blood cells,platelets,hemoglobin,neutrophils,lymphocytes,mean platelet volume,alanine aminotransferase,aspartate aminotransferase,blood creatinine,blood uric acid,blood sugar,total cholesterol,triglycerides,FT3,FT4,TSH,color Doppler TIRADS grades,pathology,etc,and NLR values were calculated from peripheral blood neutrophils / lymphocytes.The collected data was imported into SpSS20.0 for analysis,and determine the NLR and TIRADS classification thresholds.The NLR-TIRADS rating score ranges from 0 to 2,as follows: a score of 2,high NLR and high TIRADS rating group(NLR ? 2.01,TIRADS grades ? 4c);a score of 1,high NLR or high TIRADS classification group(NLR ?2.01 or TIRADS grades ? 4c);score is 0,low NLR and low TIRADS grades group(NLR <2.01,TIRADS grades < 4c).Results:1.There are more women than men in the sex composition of thyroid nodules;2.patients in the benign nodule group are older than the malignant nodule group(P = 0.002)3.The levels of white blood cells,neutrophils,and NLR in the malignant nodule group were higher than those in the benign nodule group(P<0.001),while the lymphocyte value was lower than that in the benign nodule group(P<0.001);4.The area under the curve that NLR guides the identification of benign and malignant thyroid nodules in the ROC curve was 0.754,the optimal cut-off value was 2.01,and the sensitivity and specificity were 58.2% and 83.1%,respectively,and the malignant thyroid nodules in NLR?2.01 group were significantly more than those in NLR <2.01 group(P<0.001);5.The proportion of malignant nodules in NLR-TIRADS grade 2 group was significantly higher than that in group 0(P<0.001);6.101 cases of malignant thyroid nodules with NLR ?2.01 or TIRADS grade ?4c than those with TIRADS grade ?4c alone;7.After comparing of NLR-TIRADS classification group and single TIRADS grading proportion of malignant thyroid nodules,it was found that the proportion of malignant nodules in the NLR-TIRADS classification 2 group was significantly higher than that in the single TIRADS classification ?4c group(P = 0.015),but there was no significant difference from the proportion of malignant nodules in TIRADS grade 5(P = 0.120);the proportion of malignant nodules in the NLR<2.01 and TIRADS grade ? 4c group was significantly lower than that of the single TIRADS grade ? 4c(P = 0.007),but there was no significant difference from the proportion of malignant nodules in TIRADS 4b grade(P = 0.596);the proportion of malignant nodules in the NLR ? 2.01 and TIRADS grade <4c group was significantly higher than that in the single TIRADS grade <4c group(P<0.001);And The proportion of malignant nodules in the NLR-TIRADS grade 0 group was significantly lower than that in the single TIRADS grade <4c group(P = 0.001).Conclusion:1.Using NLR ?2.01 combined with TIRADS grade ?4c as the screening basis for malignant thyroid nodules can reduce the missed diagnosis rate of TIRADS grade ?4c alone;2.The NLR-TIRADS grading score method is more effective in diagnosing benign and malignant thyroid nodules than using TIRADS grading alone.Low-cost stratification based on the NLR-TIRADS grading score may be a new method to predict malignant thyroid nodules.