Evaluation of Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio and Mean Platelet Volume in Patients with Branchial Cleft Cyst

Abstract

Branchial cleft cysts are benign masses of the head and neck. Etiopathogenesis is unclear and many factors such as inflammatory mechanisms can play a role. The aim of our study is to investigate the predictive value of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and mean platelet volume (MPV), which are hematologic inflammatory markers, in branchial cleft cyst (BCC). The records of 27 patients who were operated with the diagnosis of BCC in the ENT clinic between January 2011 and March 2020 and 27 healty subjects were retrospectively reviewed. The control group consisted age and sex-matched subjects scheduled for rhinoplasty. Neutrophil, lymphocyte, platelet and MPV values were recorded from the complete blood count samples for all participants. The statistical relationship for NLR, PLR and MPV values between the patient and the control groups was investigated. The NLR values of the patients were significantly lower than the healthy controls (p:0.007). But no statistically significant correlation was found for PLR (p:0.586) and MPV(p:0.676) values between the groups. This is the first study to evaluate the significance of NLR, PLR and MPV in branchial cleft cyst. Decreased NLR may be used as a predictive marker for BCC. But PLR ande MPV should not be used to predict branchial cleft cyst.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-021-02789-1.

Introduction

Branchial cleft cysts (BCC), also defined as cervical lymphoepithelial cysts, are benign neck masses whose surface is surrounded by epithelium and the wall is formed by lymphoid tissue. Characteristically, they occur along the anterior border of the sternocleidomastoid muscle in the lateral neck between the hyoid bone and the suprasternal notch. The mechanism of formation of branchial cleft cysts is not clearly known. Until now, four theories have been proposed regarding their formation: branchial apparatus theory, cervical sinus theory, thymopharyngeal theory, inclusion theory. The latest and most interesting of these four theories is the inclusion theory. According to this theory, BCCs develop as a result of the cystic transformation of cervical lymph nodes. Although it is not known exactly what causes the cystic change in the lymph node, it has been suggested that the epithelium entering the lymph node stimulates cystic change. The changes within the cervical lymph nodes cause an inflammatory response leading to a lateral neck swelling. However, it is possible that multiple mechanisms to play a role in this process [1, 2].

The neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and mean platelet volume (MPV) in the blood have recently come to the fore as an easy-to-measure and practical method that provides valuable information in the diagnosis of various diseases and determining their prognoses [3]. The importance of these hematologic inflammatory markers has been demonstrated in studies conducted in otorhinolaryngology diseases such as head and neck tumors [4–6], sudden hearing loss [7], tinnitus [8], vestibular neuritis [9]. Considering that chronic inflammation may also play a role in the etiopathogenesis of branchial cysts, these inflammatory parameters may be an important marker in the diagnosis of BCC. However, there is no study evaluating these markers in patients with BCC yet.

The aim of our study is to investigate the diagnostic value of NLR, PLR and MPV, which are among the parameters of complete blood count in branchial cyst.

Methods

This retrospective study was performed in accordance with the requirements of the declaration of Helsinki, after obtaining approval by the Ethics Committee of the tertiary research hospital (decision number 2011-KAEK-25 2021/01–02). The records of patients who were operated with the diagnosis of BCC in the ENT clinic between January 2011 and March 2020 were retrospectively reviewed. All of patients had second branchial cleft cyst. The patients scheduled for rhinoplasty in our clinic were included in the study as a control group. The control group was formed age and sex-matched patients. The digital patient files were evaluated in terms of age, gender, preoperative complete blood count, and post-operative histopathological diagnosis. Neutrophil, lymphocyte, platelet and MPV values were recorded from the complete blood count samples taken approximately one week before the preoperative period. NLR (neutrophil count/lymphocyte count) and PLR (platelet count/lymphocyte count) values were calculated. The peripheral vein blood samples were examined with the mindray BC-6800 device.

The exclusion criteria were as follows: acute or chronic infectious diseases, haematologic and cardiac disorders, autoimmune diseases, endocrinologic diseases, hepatic and renal diseases, cancers, inflammatory or systemic diseases that could have an effect on blood counts.

Data analysis was performed with the SPSS software, version 23.0 (Statistical Package for the Social Sciences, Chicago, IL, USA). The statistical relationship for NLR, PLR and MPV values between the patient and the control groups was investigated. The distribution of the data was investigated with the Kolmogorov–Smirnov test. The independent-samples t-test was used to evaluate difference among groups for normal distribution of continuous variables and Mann–Whitney U test was used for non-normal distribution. P value < 0.05 was considered statistically significant.

Results

The study was performed with 54 patients consisting of 30 males and 24 females with mean age of 35.79 ± 14.7 years. There were twenty seven patients in both groups. The mean age of the patient and the control group was 36.07 ± 15.2 and 35,51 ± 14.47, respectively. There was no statistically significant difference between the groups in terms of mean age and gender.

The mean NLR of the patient and the control group was 1.77 ± 0.46 and 2.25 ± 0.74 respectively (p:0,007). The mean lymphocyte counts of the patient and the control group was 2.53 ± 0.64 × 10³ and 2.18 ± 0.58 × 10³, respectively (p: 0.044). The mean PLR of the patient and the control group was 113.42 ± 39.73 and 121.88 ± 40.81, respectively (p:0.586). The mean MPV of the patient and the control group was 8.95 ± 0.96 fl and 8.81 ± 1.39 fl, respectively (p:0.676). The lymphocyte counts of the patients were significantly higher than the healthy controls and the NLR values of the patients were significantly lower than the healthy controls. But no statiscally singnificant corelation was found for PLR and MPV values between the groups. Supplemental Table 1 shows the comparison of the demographic features and haematological parameters of both groups.

Discussion

Branchial cleft cysts are common congenital benign masses in the lateral neck [10]. These cysts are typically occur as slow growing swelling in the neck between the ages of 10 and 40 [11]. BCCs are usually asymptomatic, but patients often notify a history of intermittent swelling and sensitiviness associated with upper respiratory tract infection [12]. The frequency of occurrence in both sexes is equal. There are many theories in etiology and there is no consensus. It is obvious that there are many factors that trigger the growth of the cyst in the neck [13]. However, to our knowledge, there are no real reports of specific factors that can trigger cyst growth, and no reports have been found specifically evaluating inflammatory markers.

Systemic inflammation can occur as a result of infection, tissue damage, immune disorder, benign and malign neoplasms [14]. Neutrophils, lymphocytes and platelets are the most important blood elements related in the inflammation process. An increase in neutrophil and platelet counts and a decrease in lymphocyte count are observed in this process [3]. MPV levels correlate with platelet activity and function. Proinflammatory cytokines and acute phase markers secreted in the inflammatory process affect megakaryopoiesis and this may lead to a decrease in platelet volume [15]. NLR, PLR and MPV values are easily calculated and cost-effective tests. It is suggested to use MPV, PLR and NLR as new markers showing systemic inflammation and their use has increased considerably in recent years [3].

In studies conducted in the discipline of otorhinolaryngology, it has been reported that increased NLR and PLR values are associated with vestibular neuritis [9] and increased NLR and MPV values with idiopathic tinnitus [8]. Koçak et al. stated that increased NLR values are a poor prognostic factor for sudden hearing loss [7]. Eryilmaz et al. also reported that decreased MPV values can be used as a high predictive marker to indicate choleasteotoma in children [16].

On the other hand, there are many studies investigating these parameters as diagnostic and prognostic markers in head and neck tumors. It has been reported that increased NLR value is a poor prognostic factor in head and neck cancers such as the oral cavity, nasopharynx, oropharynx, larynx, and hypopharynx [17]. It has been shown that the NLR value can be used in the differentiation of benign and malign in parotid tumors [18], laryngeal tumors [19] and thyroid tumors [20, 21]. Studies have reported that increased pretreatment NLR values can be used as inflammatory markers for parotid malignancy [18], laryngeal malignancy [19] and thyroid malignancy [20]. Kuzucu et al. reported significantly increased PLR value of patients in the malignant parotid tumor group compared to healthy control group and benign tumor group [22]. Similarly, increased PLR value has been shown to be associated with decreased survival in head and neck cancers such as nasopharynx [23], larynx [24], sinonasal [25] and tongue [26]. Mao et al. found increased PLR value in patients with more advanced laryngeal cancer stage [24]. Eryılmaz et al. also reported that MPV value increased in patients with head and neck cancer compared to healthy controls [27].

In the study we planned with the thought that inflammation triggers the formation or growth of cysts, we found that PLR and MPV values do not have a predictive value in patients with BCC. On the other hand, contrary to expectations, we found a statistically significant decrease in NLR values expected to increase in chronic inflammation. Based on these results, we think that BCC does not cause chronic systemic inflammation or that chronic systemic inflammation does not trigger BCC formation.The decrease in NLR due to the significant increase in lymphocyte count in patients compared to the control group may be related to the presence of viral upper respiratory tract infection that patients with BCC often had in their histories.

This study has limitations such as being retrospective, single centered, and low number of patients. Another limitation is that acute phase reactants such as C-reactive protein and erythrocyte sedimentation rate have not been evaluated.

Conclusion

This research is the first study examining the NLR, PLR and MPV values in the patients with BCC. These inflammatory markers are easy to use and inexpensive. It has been shown that they are important independent predictive markers especially in the diagnosis and prognosis of head and neck cancers. In this context, demonstrating that there is no increase in these parameters in patients with BCC in our study supports that these markers can be used in the differentiation of malignant and benign head and neck tumors. However, new prospective studies with a larger patient group are needed.

Supplementary Information

Below is the link to the electronic supplementary material.

Funding

There is no funding sources.

Declarations

Conflict of interest

Osman Durgut declares that he has no conflict of interest.

Sündüz Gencay declares that he has no conflict of interest.

Ömer Faruk Gökgün declares that he has no conflict of interest.