Tugba Han Öner Yilmaz1*, Baha Arslan1, Hasan Yerli2, Varlık Erol1, Tevfik Avci1, Mustafa Agah Tekindal3 and Huseyin Gulay1
1Baskent University of Medicine General Surgery Department
2Baskent University of Medicine Radiology Department
3Selcuk University, Faculty of Veterinary Medicine Department of Biostatistics
*Corresponding Author: Tugba Han Öner, Baskent University of Medicine General Surgery Department.
Received: December 17, 2019; Published: January 17, 2020
Background: This study evaluated the relationship between preoperative neutrophil / lymphocyte ratio - platelet / lymphocyte ratio, clinicopathological, radiological factors, and axillary lymph node metastasis in stage I-III breast cancer to determine if axillary surgery can be safely omitted in selected patients.
Methods: The study included 158 Stage I-III breast cancer patients operated on at Baskent University Zubeyde Hanim Research Center between 2011 and 2018. The incidence of axillary lymph node metastasis was correlated with clinical, radiological, pathological, and laboratory (neutrophil count to lymphocyte count, platelet count to lymphocyte count) findings by univariate and multivariate analyses. Sensitivity and specificity calculations, positive predictive value, negative predictive value, positive and negative Likelihood Ratio (accuracy ratio), and exact accuracy were calculated for neutrophil/lymphocyte ratio cut-off values of 3.5 and 1.
Results: Neutrophil and platelet values were significantly higher in patients with lymph node metastasis. Neutrophil / lymphocyte ratio - platelet / lymphocyte ratio values were higher in patients with axillary lymph node metastasis, but this was not statistically significant. Axillary lymph node metastasis was not associated with age, lymphocyte, monocyte count, estrogen receptor, progesterone receptor, or c-erb B2 status. The incidence of axillary lymph node metastasis was statistically significantly higher in the presence of lymphovascular invasion. Sensitivity, specificity, positive predictive value, and negative predictive value were 93.85%, 16.67%, 44.9%, and 78.9% respectively for axillary lymph node metastasis while the neutrophil / lymphocyte ratio was ≥ 3.5. Specificity, sensitivity, positive predictive value, and negative predictive value were 97.78%, 9.23%, 75.0%, and 59.9% respectively for axillary lymph node metastasis while the neutrophil / lymphocyte ratio < 1.
Conclusions: For axillary lymph node metastasis, neutrophil, platelet counts, lymphovascular invasion status, radiological and pathological mass size, and presence of radiological axillary lymphadenopathy are the statistically significant independent variables. They provide information that can help surgeons decide on the treatment of breast cancer patients with specific neutrophil / lymphocyte ratio values (neutrophil / lymphocyte ratio < 1 and neutrophil / lymphocyte ratio ≥ 3.5).
Keywords: Neutrophil / Lymphocyte Ratio; Trombocyte / Lymphocyte Ratio; Lymph Node Metastasis; Breast Cancer
Citation: Tugba Han Öner., et al. “Neutrophil / Lymphocyte Ratio (NLR) – Trombocyte / Lymphocyte Ratio (TLR): A Predictor of Axillary Lymph Node Metastasis in Breast Cancer Patients?". Acta Scientific Medical Sciences 4.2 (2020): 115-121.
Copyright: © 2020 Tugba Han Öner., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.