Can surgery decision be made based inflammatory makers and TSH level instead secondary biopsy in Bethesda type 3-4-5 thyroid nodules? Relationship between inflammatory makers and malignancy

Background: Thyroid nodules are important pathologies due to their 5-15% risk of malignancy, which increases with age. Pathology results for patients with suspicious thyroid nodules found on ultrasonography and who underwent fine needle aspiration biopsy are classified according to the Bethesda System. According to the Bethesda classification, which includes six categories, patients are recommended repeat biopsy, lobectomy, molecular analysis, or total thyroidectomy based on their risk of malignancy. Research has demonstrated that inflammatory markers in the blood can be utilized for early detection of malignancy and prognosis monitoring. In this study, the predictive effect of selected inflammatory parameters and TSH levels on malignancy in Bethesda class 3, 4, and 5 patients was investigated. Materials and Methods: Patients who underwent thyroidectomy at Bolu Abant İzzet Baysal University Training and Research Hospital General Surgery Clinic between 2014 and 2023 and whose preoperative FNAB results were Bethesda class 3, 4, and 5 were included in the study. Using hemogram values, the NLR, PLR, SII, and PPR rates were calculated and compared with the patients' pathology results. The data were analyzed using the SPSS 28 package program. In all analyses, the significance value was accepted as p<0.05. Results: One hundred sixty-three patients, 71.2% female and average age 46.52, were included in the study. Of the patients, 66.3% were classified in Bethesda Category 3, 12.3% in Bethesda Category 4, and 21.5% in Bethesda Category 5. No significant relationship was found between gender, age, PLT, PPR, NEU, LYM, TSH, NLR, PLR, SII variables, and malignancy. The malignancy rates for Bethesda classes 3, 4, and 5 were 14.8%, 20%, and 80%, respectively. A significant difference was detected in LYM (p < 0.05) and TSH (p < 0.05) values among Bethesda classes. The patients were evaluated in two groups, Bethesda class 3 and class 4-5, and there was a significant difference has been detected between these two groups in terms of LYM (p<0.05), TSH (p<0.05) and PLR (p<0.05) values. The LYM, NEU, PDW, TSH, NLR, PLR, PPR, and SII variables of benign patients in the Bethesda Class 3 and Bethesda Class 4-5 groups were examined. Significant differences were found in LYM (p<0.05), TSH (p<0.05), NLR (p<0.05), and PLR (p < 0.05) values. Conclusion: In the study, a negative relationship was found between the increased Bethesda class and LYM, and a positive relationship was found between the increased Bethesda class and TSH. It was observed that none of the parameters significantly distinguished between benign and malignant cases. Keywords: thyroid, malignancy, Bethesda, inflammatory, parameter