The Value Of Peripheral Blood Multi-index In Differential Diagnosis Of Thyroid Papillary Carcinoma And Nodular Goiter

Objective: To analyze the differences in calculating ratio of inflammatory cells in peripheral blood of patients with papillary thyroid carcinoma(PTC)and nodular goiter(NG)before operation,such as ratio of neutrophils to lymphocytes(NLR),ratio of platelets to lymphocytes(PLR),systemic inflammatory index(SII),ratio of lymphocytes to monocytes(LMR)and thyroid stimulating hormone(TSH).The combined indexes were constructed to investigate the value of single and combined indexes in the differential diagnosis of papillary thyroid carcinoma and nodular goiter,in order to explore an economical and convenient diagnostic method for clinic.Methods:1.The clinicopathological data of 573 patients with thyroid nodules who need to accept operation were collected from January 1,2015 to October 31,2020 in the Department of breast and thyroid surgery,the first affiliated Hospital of University of South China.2.White blood cell count,neutrophil count,lymphocyte count,monocyte count,hemoglobin value,platelet distribution width,creatinine value,albumin value,fibrinogen value,free triiodothyronine(FT3),free thyroxine(FT4),TSH,thyroglobulin antibody(Tg Ab),thyroid peroxidase antibody(TPOAb),and calculate NLR,PLR,LMR,SII.3.The postoperative pathological results showed that the patients with nodular thyroid were NG group and the patients with papillary thyroid carcinoma were PTC group.Analyzing clinicopathological data in order to obtained the differences between PTC group and NG group.3.According to the 1:1 Propensity Score Matching,the influence of gender,age,creatinine,albumin,hemoglobin,BMI and other confounding factors on the results were eliminated by matching.After matching,the baseline characteristics of the two groups and the differences of each observation were calculated.4.For the single index or combined index with statistical difference,the subject working curve(Receiver Operating Characteristic Curve,ROC)was constructed and the area under the curve(Area Under The Curve,AUC was calculated.The optimal critical value(cutoff-value)and the corresponding sensitivity and specificity were calculated according to the Youdan index.Z test was used to infer the diagnostic efficiency of related indexes,and to compare whether there was statistical difference in their diagnostic efficacy for the nature of thyroid nodules.Results:1.The PTC group,compared with the NG group,most of them were male and younger.WBC,monocyte,platelet,TSH,NLR and PLR were all increased,while lymphocyte,SII and LMR were all decreased,with significant differences(p<0.05),while it had no statistical significance in neutrophils,platelet distribution width,fibrinogen,FT3,FT4,Tg Ab,TPOab,BMI(Body mass index),creatinine,uric acid,and hemoglobin(p>0.05).2.After Propensity Score Matching(1:1),the PTC group,in contrast to the NG group,monocytes,TSH and PLR were increased,lymphocytes and LMR were decreased with significant difference(p<0.05),while NLR and SII had no significant difference(p>0.05).3.The area of LMR under the ROC curve is 0.8011 with the sensitivity of 0.74,the specificity of 0.77,and the cutoff value of 4.46;the area of PLR under the ROC curve is 0.7207,with the sensitivity of 0.61,the specificity of 0.76,and the cutoff value of 126.17;the area of TSH under the ROC curve is 0.5709,with the sensitivity of 0.43,the specificity of 0.76,and the cutoff value of 1.22.The area of the three combined indexes(LMR,PLR,and TSH)under the ROC curve is 0.8023 with the sensitivity of 0.78,the specificity of 0.73,and the cutoff value of 0.49.4.The area of LMR,PLR,and the three combined indexes under the ROC curve is larger than that of TSH under the ROC curve(p<0.05).However,the area of LMR,PLR,and the combined three indexes under the ROC curve had no significant difference(p>0.05)when pairwise comparison were conducted on them.The verification curve was constructed by repeated sampling method(bootstrap)to test the prediction efficiency of the merger index.Conclusions:1.Preoperative peripheral blood LMR,PLR,TSH and their combined indexes have certain value in differential diagnosis of thyroid nodules.2.The diagnostic efficacy of LMR,PLR and LMR,PLR,TSH combined indexes in peripheral blood before operation was better than that of TSH,but the diagnostic efficacy of LMR,PLR and LMR,PLR,TSH combined indexes had no advantages or disadvantages.