Feasibility of The Use of Neutrophil To Lymphocyte Ratio (NLR) As An Adjunct To Cytology To Suggest Thyroid Malignancy: A Prospective Study

Abstract Background: Inflammation is known to be associated with cancer development and progression. NLR is a simple and efficient marker of inflammation in numerous malignancies. Aim: The study aimed to investigate usefulness of neutrophil to lymphocyte ratio (NLR) as an adjunct to Fine needle aspiration cytology (FNAC) to suggest thyroid malignancy confirmed by histopathological report post operatively in Bethesda class III, IV & V.Methods: Prospective observational study at a tertiary care hospital over 2 years.Results: NLR in the benign group and malignant group were 1.75+0.23 and 2.19+0.29 (mean + SD) respectively (p-value <0.001). Area under ROC curve plotted was 0.823 (p-value <0.001), with recommended cut-off of 1.9. Relatively high sensitivity and specificity at 87.5 % and 82.5% implies excellent diagnostic accuracy.Conclusion: NLR with a value of 1.9 or higher is recommended as predictor of malignancy in thyroid nodule.