Fine needle aspiration biopsy results of nodules, assessed as atypy of uncertain significance; the relationship of post-surgery pathologies of systemic immune inflammation value, pan-immune inflammation value and neutrophil-lymphocyte ratios with malignition

In our society, thyroid diseases such as nodular goiter are followed closely due to the risk of conversion to malignancy, therefore thyroid diseases constitute a serious population in outpatient clinics in practice. Among the thyroid malignancies that make up 1% of all malignancies, the most common type is papillary thyroid cancer with 80%. Fine Needle Aspiration Biopsy (FNAB) plays an important role in the cytological evaluation of thyroid nodules. The malignancy rate is 10-30% in thyroid nodules with atypia of uncertain significance according to the Bethesda Classification as a result of thyroid fine-needle aspiration biopsy. In thyroid nodules evaluated as atypia of uncertain significance as a result of fine needle aspiration biopsy, early diagnosis and surgical decision with the suspicion of malignancy are of great importance. In many recent studies, the importance of the relationship between cancer risk and inflammation is increasing. Pan immune inflammation index (PIV), systemic immune inflammation index (SII) and neutrophil lymphocyte ratio (NLR) calculated with a simple blood count are the markers showing systemic inflammation. PIV, SII and NLR have an important place for diagnosis, prognosis and treatment follow-up in many cancer types. In our study, thyroid fine-needle aspiration biopsy results of patients with atypia of uncertain significance were compared with those with malignant or benign post-surgical final pathology in terms of neutrophil-lymphocyte ratio, systemic immune inflammation index, and pan immune inflammation index, which are systemic immune inflammation markers. Between January 2017 and December 2022, 120 patients who underwent total thyroidectomy with atypia of uncertain significance as a result of fine needle aspiration biopsy from the thyroid nodule in the General Surgery Clinic of Fırat University Faculty of Medicine were examined. Sixty of these patients had thyroid diseases with a benign character and 60 with a malignant character, with a definitive postoperative pathology report. The mean PIV value of the patients included in the study in the benign thyroid disease group was 217.64, the mean SII value was 502.64, and the N/L ratio was 1.875. In the group with malignant thyroid disease, the mean PIV value was 327.95, the mean SII value was 644.56, and the N/L ratio was 2.26. PIV, SII, N/L ratios of the group with malignant thyroid disease were found to be statistically significantly higher than those of benign thyroid diseases. As a result of our study, it was observed that NLR, SII and PIV values calculated by complete blood count before surgery in patients with atypia of uncertain significance as a result of FNAB were higher in the group of patients whose pathology was malignant after surgery than in the benign thyroid disease group. İn conclusion, our study showed that if the PIV, SII, and NLR values calculated in patients with atypia of uncertain significance in FNAB results are found to be high in the first biopsies, it can support malignancy, thus surgery can be recommended to the patient without the need for a second biopsy. Moreover; If the calculated PIV, SII and NLR values are found to be low in the first biopsies, it is anticipated that radiological follow-up of the nodules can be recommended without recommending surgery to the patient. Keywords: Atypia of uncertain significance, fine needle aspiration biopsy, neutrophil lymphocyte ratio, systemic immune inflammation value, pan immune inflammation value.