Preoperative Pan-Immune-Inflammation Value as a Predictor of Malignancy in Thyroid Nodules With Atypia of...

Thyroid nodules with atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) represent a heterogeneous group with variable malignancy risk, posing a significant challenge for preoperative clinical decision-making. There is a need for inexpensive, readily accessible biomarkers to improve risk stratification in this indeterminate category.

To investigate the association between preoperative pan-immune-inflammation value (PIV) and malignancy in patients with thyroid nodules diagnosed as AUS/FLUS on fine-needle aspiration biopsy.

This retrospective study included patients who underwent thyroid surgery after a cytologic diagnosis of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) on fine-needle aspiration. Preoperative complete blood count parameters, including neutrophil, lymphocyte, monocyte, and platelet counts, were retrieved from medical records and used to calculate the PIV. Patients were stratified according to final histopathologic diagnosis as benign or malignant. Preoperative PIV values were compared between the 2 groups to assess their association with malignancy.

Among patients with AUS/FLUS cytology, preoperative PIV values were significantly higher in those with malignant final pathology compared with benign cases. This finding suggests an association between elevated systemic immune-inflammatory status and malignancy in indeterminate thyroid nodules.

Preoperative PIV may serve as a simple and readily available adjunctive biomarker to assist in malignancy risk stratification of AUS/FLUS thyroid nodules. Its use may contribute to more informed surgical decision-making and help reduce unnecessary surgical interventions. Prospective studies are warranted to validate these findings and to determine clinically relevant cutoff values.