Neoplasms

Skin and Connective Tissue Diseases

All Conditions

Symptoms and General Pathology

Breast Neoplasms

Neoplasm Metastasis

Breast Diseases

Skin Diseases

Neoplastic Processes

Mastectomy for breast cancer Blood sample for Complete Blood Cell Count and other blood parameters (Delta Neutrophil Index, Immature Granulocyte Count)

Mastectomy

Background: Breast cancer ranks first among cancer types seen in women in our country and all over the world, and second after lung cancer in cancer-related deaths. Despite the recent increase in its incidence, mortality has decreased due to early diagnosis and advances in neoadjuvant therapy. Classically, lymph node status, tumor size, histological type and grade, age, and ethnicity are prognostic factors for this type of cancer. Bone marrow activation results from malignancies and inflammation. Tumor-related inflammation has gained importance in each stage of tumorigenesis. Host-dependent systemic inflammatory response has been found to be effective in carcinogenesis, tumor development and progression. Inadequately controlled or uncontrolled inflammatory activity may be responsible for malignant transformation. Inflammatory cell stimulation occurs in lymph node metastasis and distant organ metastases like primary tumor.As the cornerstone of the adaptive immune system, lymphocytes inhibit tumor cell proliferation, migration and destroy metastatic lesions. Monocyte-macrophages inhibit angiogenesis, tumor growth and distant spread. On the other hand, tumor-induced neutrophils can accelerate tumor metastasis. Many studies have examined the relationship between the ratios between different cell types, such as the platelet-lymphocyte ratio (PLR), and the neutrophil-lymphocyte ratio (NLR), with malignant tumors(4,10).Apart from these, mean platelet volume (MPV), which can be automatically studied in routine blood counts and shows platelet activation, has been used to show tumor activity in breast, stomach, colon and ovarian cancers.

Recent studies have identified the delta neutrophil index (DNI), which indicates the percentage of immature granulocytes (IG) in peripheral blood due to increased bone marrow activation in inflammatory conditions.It is based on counting granulocyte precursor cells under microscope. With the technological developments,IG count and DNI can be automatically evaluated from complete blood count parameters in automated systems.

In this study,the investigators aimed to determine the diagnostic value of preoperative IG number and DNI level before clinical detection of axillary lymph node metastasis, which plays an important role in the prognosis of breast cancer, and to compare these parameters with other routine inflammation markers such as white blood cell count (WBC), MPV, NLR and PLR.

Material - Methods:Patients who were older than eighteen and operated for breast pathology in Kahramanmaras Sutcu Imam University,Department of General Surgery between February 2015 and February 2020 were evaluated retrospectively.Patient data were obtained from patient epicrisis forms and preoperative laboratory and postoperative pathology results recorded in the computer system.Demographic data of the patients,routine blood tests,preoperative imaging methods, preoperative tumor size,presence of axillary lymph node metastasis and distant organ metastasis,presence of pathological axillary lymph node metastasis in the postoperative period were evaluated.

In the preoperative period, patients without axillary metastases and who did not receive neoadjuvant treatment were examined by dividing them into two groups as pathologically non-metastatic(Group NM) and metastasized(Group M) in axillary lymph node sampling.

White blood cell(WBC)count,neutrophil count,lymphocyte count,platelet count,mean platelet volume(MPV),IG count and DNI(IG percentage)were measured using an automated hematological analyzer from blood samples obtained at the preoperative previous month of surgery.Neutrophil to lymhpocyte ratio(NLR) and platelet to lymphocyte ratio(PLR) were manually calculated from the complete blood cell results.

Background: Breast cancer ranks first among cancer types seen in women in our country and all over the world, and second after lung cancer in cancer-related deaths. Despite the recent increase in its incidence, mortality has decreased due to early diagnosis and advances in neoadjuvant therapy. Classically, lymph node status, tumor size, histological type and grade, age, and ethnicity are prognostic factors for this type of cancer. Bone marrow activation results from malignancies and inflammation. Tumor-related inflammation has gained importance in each stage of tumorigenesis. Host-dependent systemic inflammatory response has been found to be effective in carcinogenesis, tumor development and progression. Inadequately controlled or uncontrolled inflammatory activity may be responsible for malignant transformation. Inflammatory cell stimulation occurs in lymph node metastasis and distant organ metastases like primary tumor.As the cornerstone of the adaptive immune system, lymphocytes inhibit tumor cell proliferation, migration and destroy metastatic lesions. Monocyte-macrophages inhibit angiogenesis, tumor growth and distant spread. On the other hand, tumor-induced neutrophils can accelerate tumor metastasis. Many studies have examined the relationship between the ratios between different cell types, such as the platelet-lymphocyte ratio (PLR), and the neutrophil-lymphocyte ratio (NLR), with malignant tumors.Apart from these, mean platelet volume (MPV), which can be automatically studied in routine blood counts and shows platelet activation, has been used to show tumor activity in breast, stomach, colon and ovarian cancers.

Recent studies have identified the delta neutrophil index (DNI), which indicates the percentage of immature granulocytes (IG) in peripheral blood due to increased bone marrow activation in inflammatory conditions.It is based on counting granulocyte precursor cells under microscope. With the technological developments,IG count and DNI can be automatically evaluated from complete blood count parameters in automated systems.

In this study, investigators aimed to determine the diagnostic value of preoperative IG number and DNI level before clinical detection of axillary lymph node metastasis, which plays an important role in the prognosis of breast cancer, and to compare these parameters with other routine inflammation markers such as white blood cell count (WBC), MPV, NLR and PLR.

Material - Methods:Patients who were older than eighteen and operated for breast pathology in Kahramanmaras Sutcu Imam University,Department of General Surgery between February 2015 and February 2020 were evaluated retrospectively.Patient data were obtained from patient epicrisis forms and preoperative laboratory and postoperative pathology results recorded in the computer system.Demographic data of the patients,routine blood tests,preoperative imaging methods, preoperative tumor size,presence of axillary lymph node metastasis and distant organ metastasis,presence of pathological axillary lymph node metastasis in the postoperative period were evaluated.

In the preoperative period, patients without axillary metastases and who did not receive neoadjuvant treatment were examined by dividing them into two groups as pathologically non-metastatic(Group NM) and metastasized(Group M) in axillary lymph node sampling.

White blood cell(WBC)count,neutrophil count,lymphocyte count,platelet count,mean platelet volume(MPV),IG count and DNI(IG percentage)were measured using an automated hematological analyzer from blood samples obtained at the preoperative previous month of surgery.Neutrophil to lymhpocyte ratio(NLR) and platelet to lymphocyte ratio(PLR) were manually calculated from the complete blood cell results.

Statistical Evaluation:IBM-Statistical Package for Social Sciences (SPSS) version 20 was used for statistical analysis. In the evaluation between independent groups;normal distribution was checked for the kolmogorov-simirnov test.While student t test or Mann Whitney U test was used in the evaluation of numerical data according to the conformity of the data to normal distribution,chi-square test was used in the evaluation of categorical data.Multivariate analysis was performed with parameters found to be significant in the evaluation of univariate analysis and predictive values of preoperative blood parameters were calculated.ROC analysis was performed to evaluate the effectiveness of WBC, NLR, PLR, DNI, IG number and MPV values,and sensitivity,specificity values and cut-off values were obtained. Numerical values are expressed as median(minimum - maximum values), categorical values as percentage (%).

patients without axillary metastases and who did not receive neoadjuvant treatment were examined by dividing them into two groups as pathologically non-metastatic (Group NM) and metastasized (Group M) in axillary lymph node sampling.

Immature Granulocyte Count and Delta Neutrophil Index Factors for Axillary Metastasis of Breast Cancer

Immature Granulocyte Count and Delta Neutrophil Index as New Predictive Factors for Axillary Metastasis of Breast Cancer

DNI and IG count calculated automatically in blood samples of the preoperative period of the invasive breast cancer patients

Kahramanmaras Sutcu Imam University

Professor, Assistant

Gland and Hormone Related Diseases

Thyroid Neoplasms

Thyroid Diseases

Thyroid Nodule

Goiter

Goiter, Nodular

Endocrine System Diseases

Endocrine Gland Neoplasms

Head and Neck Neoplasms

Selective lichtenstein procedure for inguinal hernia

Complete Blood Count

Thyroid surgery is the most common surgical procedure among endocrine surgeries. It is performed in patients with suspected malignancy, patients diagnosed with malignancy, and for toxic nodular goiter \[1\]. Fine-needle aspiration biopsy (FNAB) is used as a daily technique in preoperative evaluation to differentiate malignant and benign nodules. However, complications including hematoma formation, tumor transplantation along the needle trace, thyroid nodule infarction and vascular proliferation can be seen even in this minimally invasive procedure \[2\]. Therefore, the differentiation of benign and malignant groups using non-interventional methods before surgery has become important.

Cancer-related inflammation, including papillary thyroid carcinoma, is involved in carcinogenesis and progression of neoplastic disease \[3,4\]. Neutrophils induced by the tumor can accelerate tumor metastasis \[3,5\]. Lymphocytes, as the cornerstone of the adaptive immune system, inhibit tumor cell proliferation and migration as well as destroying metastases \[3,6\]. Previous studies have shown that increased lymphocyte count has a positive effect on better survival in patients with advanced cancer \[7\]. Furthermore, Kupffer cells, also known as liver macrophages, destroy circulating cancer cells and help the distribution of tumor cells via circulation. Therefore, routine blood tests have been investigated as a predictive or prognostic factor for carcinomas since blood parameters in these tests show whether there is inflammation. Neutrophil count, lymphocyte count, neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), mean platelet volume (MPV), and platelet distribution width (PDW) have been studied in terms of numerous malignancies \[3\].

Tumor-related inflammation is activated the bone marrow and inflammation induced by malignancies. Inflammatory activity that is poorly controlled or uncontrollable may be responsible for malignant transformation \[8\]. At this point, NLR has previously been shown to be useful in the differentiation of thyroid malignancies and benign thyroid diseases \[9\]. Delta neutrophil index (DNI) / increased number of immature granulocytes (IG) represents active bone marrow. Delta neutrophil index, which is manifested by IG formation in inflammatory and infectious events, shows changes in the white blood cell count \[10\].

This study aimed to evaluate the relation between the automatically calculated DNI/IG count and manually calculated NLR from the preoperative complete blood count (CB) parameters, and thyroid malignancies with a cost-effective non-invasive method before surgery or biopsy as the indicator of the malignant inflammatory response in the differentiation of nodular goiter and thyroid malignancy.

Material-Methods Patients over the age of 18 who underwent thyroid surgery and who were operated on non-malignant benign causes (inguinal hernia) under selective conditions without any thyroid disease between November 2014 and November 2019 in Kahramanmaraş Sütçü İmam University Department of General Surgery were evaluated in this retrospective case-control cohort study. Patients in the thyroid pathology group (Group T) were divided into two subgroups according to their pathologic results: malignant (Group M) and benign thyroid disorders (Group B). Patients operated for inguinal hernia, were selected as control group (Group C).

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Preoperative biopsy results of patients undergoing FNAB in the preoperative period were investigated according to the Bethesda Classification System \[11\]. Neutrophil - lymphocyte count in the routine complete blood count (CBC) values, which were measured in the preoperative period and the postoperative sixth-month follow-ups, were recorded retrospectively and calculated manually. DNI (IG percentage) and IG counts were recorded from the values measured automatically in the CBC performed in the preoperative period and the postoperative sixth-month. Patient data were obtained from patient epicrisis forms and preoperative laboratory and postoperative pathology results recorded in the computer system.

Statistical Analysis The power analysis of the study was conducted with G-Power 3.0.10 programming system. Estimated power analysis and the sample size with an 0.8 power and effect size 0.1 according to three groups evaluation for 2 repeated measures in need of total 246 samples.

Statistical analysis was performed using IBM Social Package for the Social Sciences (SPSS) version 20 software. In the evaluation of independent groups, Kolmogorov-Smirnov and Shapiro-Wilk tests were used to determine if the distrubiton of variables were normal or not. Student t-test or Mann-Whitney U test was used to evaluate the numerical data between Group C and Group T. ANOVA or Kruskal Wallis test was used to evaluate numerical data for subgroup relations with Group C. Chi-square test or Fischer's exact test was used to evaluate categorical data. The repeated-measures ANOVA was used to evaluate the differences between the preoperative and postoperative periods. The data were evaluated using Posthoc Tukey's B test following the variance analysis. Sensitivity and specificity values and cut-off values were obtained via the receiver operating characteristic (ROC) analysis to evaluate the effectiveness of NLR, IG count, and DNI.

Numerical data were expressed as mean ± standard deviation (minimum-maximum values) or median (minimum-maximum values) according to the normal distribution. Categorical values were expressed as percentages (%).

Delta Neutrophil Index and Neutrophil Lymphocyte Ratio in Thyroid Malignancy

Delta Neutrophil Index and Neutrophil Lymphocyte Ratio in Differentiation of Thyroid Malignancy and Nodular Goiter

The correlation between DNI and thyroid cancer

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization	Link
Immature Granulocyte Count and Delta Neutrophil Index Factors for Axillary Metastasis of Breast Cancer	NCT04729647	Breast Cancer Breast Cancer I...	Mastectomy	18 Years -	Kahramanmaras Sutcu Imam University
Delta Neutrophil Index and Neutrophil Lymphocyte Ratio in Thyroid Malignancy	NCT04425512	Thyroid Cancer Thyroid Nodule Thyroid Disease... Delta Neutrophy... Immature Granul... Neutrophyl to L...	Complete Blood ...	18 Years -	Kahramanmaras Sutcu Imam University

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