An Evaluation of Immature Granulocytes as Predictors of Malignancy in Patients with Atypia of Undetermined Significance Thyroid Nodules

Abstract This retrospective study aimed to evaluate hematological and inflammatory markers as predictors of thyroid cancer in patients with atypia of undetermined significance thyroid nodules. A total of 174 patients with atypia of undetermined significance who underwent thyroidectomy were included. Pre- and postoperative immature granulocyte counts, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio were analyzed after achieving euthyroid status. Propensity score matching for age and gender resulted in a final cohort of 128 patients (64 benign and 64 malignant). Static preoperative and postoperative immature granulocyte values did not differ significantly between the benign and malignant groups; however, the delta immature granulocyte value, defined as the change between pre- and postoperative measurements, was significantly lower in malignant cases (p=0.007). Receiver operating characteristic analysis demonstrated an area under the curve of 0.651 at a cut-off value of≤− 0.01, with a sensitivity of 46.2% and a specificity of 79.2%. Univariate logistic regression revealed that delta immature granulocytes independently predicted malignancy in the overall cohort (odds ratio=3.273 and p=0.007) and in patients younger than 55 years (odds ratio=5.082 and p=0.007), whereas this association was not observed in patients aged 55 years and older. The neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios were not significant predictors. These findings suggest that dynamic changes in immature granulocyte levels between the pre- and postoperative periods, rather than single-time-point measurements, may serve as a cost-effective and accessible complementary tool for malignancy prediction in atypia of undetermined significance thyroid nodules.