Research Article Volume 7 • Issue 1 60 Value of Preoperative Neutrophil-to-Lymphocyte Ratio in Predicting Thyroid Cancer in Intermediate Category Fine Needle Aspiration Pathology Yasar Ozdenkaya, Pelin Basim, Naciye Cigdem Arslan * Afliation: Department of General Surgery, Istanbul Medipol University, 34320, Istanbul, Turkey *Corresponding author: Naciye Cigdem Arslan, Department of General Surgery, Istanbul Medipol University, 34320, Istanbul, Turkey Citation: Yasar Ozdenkaya, Pelin Basim, Naciye Cigdem Arslan. Value of Preoperative Neutrophil- to-Lymphocyte Ratio in Predicting Thyroid Cancer in Intermediate Category Fine Needle Aspiration Pathology. Journal of Surgery and Research. 7 (2024): 60-65. Received: January 30, 2023 Accepted: February 05, 2023 Published: February 09, 2024 Abstract Context: The management of thyroid nodules with intermediate category of the Bethesda System for Reporting Thyroid Cancer (TBSRTC) is still debatable. Objective: To investigate the diagnostic accuracy of neutrophil-to- lymphocyte ratio (NLR) in detecting cancer in intermediate TBSRTC categories. Design: Data of the patients who underwent thyroidectomy between 2012 and 2018 were analyzed retrospectively. Subjects and Methods: Demographic characteristics, complete blood count, thyroid stimulating hormone (TSH) value, TBSRTC categories and postoperative pathology of the patients were collected. The association with preoperative NLR and postoperative pathology was assessed. Results: Of 146 patients included in the study, 57 (39%) were in TBSRTC III, IV and V category. The mean NLR in this subgroup was 2.1±0.8 and similar between TBSRTC III, IV and IV groups (p=0.737). Thyroid cancer was detected in 38 (66.7%) patients. The mean NLR was 2.4±0.8 in thyroid cancers and signifcantly higher when compared with patients with benign postoperative pathology (1.6±0.4, p=0.014). There was a signifcant diference between papillary and follicular cancer; the mean NLR was 2.3±0.8 in papillary cancer and 2.6±0.7 in follicular cancer patients (p=0.005). The cut-of value of NLR for predicting cancer at 89% sensitivity and 53% specifcity was 1.6 (Area under curve: 0.769, 95% confdence interval: 0.643-0.895, p=0.001). Conclusion: Preoperative NLR is elevated in patients with thyroid cancer in intermediate TBSRTC categories. Despite low diagnostic accuracy, considering its availability and low costs, NLR has merit for further studies. Keywords: Goiter, Bethesda classifcation, fne needle aspiration biopsy, papillary thyroid carcinoma, thyroid nodule, neutrophil-to-lymphocyte ratio. Introduction During last decades, the incidence of thyroid cancer has been nearly tripled from 4.9 to 14.3 per 100,000 people in United States due to increasing diagnosis of thyroid nodules[1]. The major issue in evaluation of thyroid pathologies is distinguishing benign and malign nodules. Up to 15% of all clinically detected thyroid nodules are found to be malignant [2]. Ultrasonography and fne needle aspiration biopsy (FNAB) are the most common diagnostic tools with high specifcity to detect thyroid cancer, however one-third of the cytologic evaluation cannot provide a certain diagnosis.