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The performance of various laboratory parameters to differentiate follicular thyroid carcinoma and follicular thyroid adenoma

  • Satriya Kelana ,
  • Dwi Hari Susilo ,
  • Sahudi ,


Background: Thyroid cancer continues to be a problem all over the world, with the number of cases increasing year after year. We aimed to examine the association between various laboratory parameters and follicular-type thyroid nodules. We also examined the performance of several parameters to differentiate malignant and benign follicular thyroid lesions.

Methods: This is a retrospective cohort study to determine the association between various laboratory parameters and follicular-type thyroid nodules in Dr. Soetomo General Hospital, Surabaya.

Results: A total of 62 patients were examined. The NLR in the follicular carcinoma group was 2.26 ± 1.35, whereas the NLR in the adenoma group was 2.72 ± 0.74. The average lymphocyte in the follicular carcinoma group was significantly higher than the adenoma group, 2.20 ± 0.78 vs. 1.76 ± 0.82. With a cut-off value of 2.405, NLR had a 69.40% accuracy rate for diagnosing a follicular adenoma (sensitivity: 70%; specificity: 69.2%, PPV: 30.4%, NPV: 92.3%). Lymphocyte had an accuracy of 80.6% in detecting follicular carcinoma (cut-off: 1.625; sensitivity: 80.8%; specificity: 80.0%, PPV: 95.5%, NPV: 44.4%). With an accuracy of 72.6% (cut-off: 270.500; sensitivity: 71.2%; specificity: 80.0%, PPV: 94.9%, NPV: 34.8%), platelet value is a promising parameter for differentiating follicular cancer and adenoma. There was a significant relationship between NLR, lymphocyte, and platelet with follicular-type thyroid nodules (P < 0.05 for all).

Conclusion: NLR, lymphocytes, and platelets are potential biomarkers that can be used to differentiate follicular thyroid carcinoma and follicular thyroid adenoma.


  1. Olson E, Wintheiser G, Wolfe KM, Droessler J, Silberstein PT. Epidemiology of Thyroid Cancer: A Review of the National Cancer Database, 2000-2013. Cureus. 2019;11(2):e4127. Published 2019 Feb 24. doi:10.7759/cureus.4127.
  2. World Health Organization. Indonesia Source GLOBOCAN 2018. Int Agency Res Cancer. 2019;256:1–2.
  3. Sembiring YE, Reksoprawiro S, Panuwun T. Correlation between p53 protein expressions in the incidence of metastasis in well-differentiated thyroid cancer. Folia Medica Indones. 2009;45(No. 3):193–203.
  4. Prete A, Borges de Souza P, Censi S, Muzza M, Nucci N, Sponziello M. Update on Fundamental Mechanisms of Thyroid Cancer. Front Endocrinol (Lausanne). 2020;11:102. Published 2020 Mar 13. doi:10.3389/fendo.2020.00102.
  5. Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26(1):1-133. doi:10.1089/thy.2015.0020.
  6. McHenry CR, Phitayakorn R. Follicular adenoma and carcinoma of the thyroid gland. Oncologist. 2011;16(5):585-593. doi:10.1634/theoncologist.2010-0405.
  7. Fnais N, Soobiah C, Al-Qahtani K, et al. Diagnostic value of fine needle aspiration BRAF(V600E) mutation analysis in papillary thyroid cancer: a systematic review and meta-analysis. Hum Pathol. 2015;46(10):1443-1454. doi:10.1016/j.humpath.2015.06.001.
  8. Vargas-Salas S, Martínez JR, Urra S, et al. Genetic testing for indeterminate thyroid cytology: review and meta-analysis. Endocr Relat Cancer. 2018;25(3):R163-R177. doi:10.1530/ERC-17-0405.
  9. Kocer D, Karakukcu C, Karaman H, Gokay F, Bayram F. May the neutrophil/lymphocyte ratio be a predictor in the differentiation of different thyroid disorders?. Asian Pac J Cancer Prev. 2015;16(9):3875-3879. doi:10.7314/apjcp.2015.16.9.3875.
  10. Zhang D, Tang J, Kong D, et al. Impact of Gender and Age on the Prognosis of Differentiated Thyroid Carcinoma: a Retrospective Analysis Based on SEER. Horm Cancer. 2018;9(5):361-370. doi:10.1007/s12672-018-0340-y.
  11. Albores-Saavedra J, Henson DE, Glazer E, Schwartz AM. Changing patterns in the incidence and survival of thyroid cancer with follicular phenotype--papillary, follicular, and anaplastic: a morphological and epidemiological study. Endocr Pathol. 2007;18(1):1-7. doi:10.1007/s12022-007-0002-z.
  12. Moore MM, Chua W, Charles KA, Clarke SJ. Inflammation and cancer: causes and consequences. Clin Pharmacol Ther. 2010;87(4):504-508. doi:10.1038/clpt.2009.254.
  13. Cunha LL, Marcello MA, Ward LS. The role of the inflammatory microenvironment in thyroid carcinogenesis. Endocr Relat Cancer. 2014;21(3):R85-R103. Published 2014 Apr 28. doi:10.1530/ERC-13-0431.
  14. Saputra, H. M., & Hakim, L. The Prognostic Role of Neutrophil-to-Lymphocyte Ratio (NLR) in Testicular Germ Cell Tumor (GCT). Folia Medica Indonesiana. 2022;58(1). p39–45.
  15. Lowsby R, Gomes C, Jarman I, et al. Neutrophil to lymphocyte count ratio as an early indicator of blood stream infection in the emergency department. Emerg Med J. 2015;32(7):531-534. doi:10.1136/emermed-2014-204071.
  16. Minerva B, Ali I, Tanggo EH, Danardono E. Neutrophil lymphocyte ratio and clinical response after neoadjuvant chemotherapy with cyclophosphamide, doxorubicin, and 5-fluorouracil regiment in locally advanced breast cancer. Eurasian J Biosci. 2020;14(1):2473–8.
  17. Ito Y, Onoda N, Kihara M, Miya A, Miyauchi A. Prognostic Significance of Neutrophil-to-Lymphocyte Ratio in Differentiated Thyroid Carcinoma Having Distant Metastasis: A Comparison With Thyroglobulin-doubling Rate and Tumor Volume-doubling Rate. In Vivo. 2021;35(2):1125-1132. doi:10.21873/invivo.12358.
  18. Gong W, Yang S, Yang X, Guo F. Blood preoperative neutrophil-to-lymphocyte ratio is correlated with TNM stage in patients with papillary thyroid cancer. Clinics (Sao Paulo). 2016;71(6):311-314. doi:10.6061/clinics/2016(06)04.
  19. Manatakis DK, Tseleni-Balafouta S, Balalis D, Soulou VN, Korkolis DP, Sakorafas GH, et al. Association of Baseline Neutrophil-to-Lymphocyte Ratio with Clinicopathological Characteristics of Papillary Thyroid Carcinoma. Int J Endocrinol. 2017. p1-7. DOI: 10.1155/2017/8471235.
  20. Prabawa IPY, Bhargah A, Liwang F, Tandio D, Tandio A, Lestari AAW, Budiana IPG, Manuaba IBAP. Pretreatment Neutrophil-to-Lymphocyte ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) as a Predictive Value of Hematological Markers in Cervical Cancer. Asian Pacific Journal of Cancer Prevention. 2019;20(3):863-868. doi:10.31557/APJCP.2019.20.3.863.
  21. French JD, Weber ZJ, Fretwell DL, Said S, Klopper JP, Haugen BR. Tumor-associated lymphocytes and increased FoxP3+ regulatory T cell frequency correlate with more aggressive papillary thyroid cancer. J Clin Endocrinol Metab. 2010;95(5):2325-2333. doi:10.1210/jc.2009-2564.
  22. Miftahussurur M, Waskito LA, Syam AF, et al. Analysis of risks of gastric cancer by gastric mucosa among Indonesian ethnic groups. PLoS One. 2019;14(5):e0216670. Published 2019 May 9. doi:10.1371/journal.pone.0216670.
  23. El Bairi K, Haynes HR, Blackley E, et al. The tale of TILs in breast cancer: A report from The International Immuno-Oncology Biomarker Working Group. NPJ Breast Cancer. 2021;7(1):150. Published 2021 Dec 1. doi:10.1038/s41523-021-00346-1.
  24. Bastid J, Bonnefoy N, Eliaou JF, Bensussan A. Lymphocyte-derived interleukin-17A adds another brick in the wall of inflammation-induced breast carcinogenesis. Oncoimmunology. 2014;3:e28273. Published 2014 Mar 27. doi:10.4161/onci.28273.
  25. He JR, Shen GP, Ren ZF, et al. Pretreatment levels of peripheral neutrophils and lymphocytes as independent prognostic factors in patients with nasopharyngeal carcinoma. Head Neck. 2012;34(12):1769-1776. doi:10.1002/hed.22008.
  26. Palacios-Acedo AL, Mège D, Crescence L, Dignat-George F, Dubois C, Panicot-Dubois L. Platelets, Thrombo-Inflammation, and Cancer: Collaborating With the Enemy. Front Immunol. 2019;10:1805. Published 2019 Jul 31. doi:10.3389/fimmu.2019.01805.

How to Cite

Kelana, S., Susilo, D. H., & Sahudi. (2022). The performance of various laboratory parameters to differentiate follicular thyroid carcinoma and follicular thyroid adenoma. Bali Medical Journal, 11(3), 1461–1467.