Immature Granulocyte Count and Delta Neutrophil Index as New Predictive Factors for Axillary Metastasis of Breast Cancer

Abstract

Objective: To determine the diagnostic value of preoperative immature granulocyte (IG) count and delta neutrophil index (DNI) level before clinical detection of axillary lymph node metastasis. Study Design: Cohort study. Place and Duration of Study: Department of General Surgery, Kahramanmaras Sutcu Imam University, Onikisubat, Turkey from February 2015 to February 2020. Methodology: Patients older than 18 years and operated for breast pathologies in the study period were evaluated retrospectively. Patients without axillary or distant organ metastasis, and who did not receive neoadjuvant chemotherapy were examined by dividing them into two groups as pathologically non-metastatic axilla (Group NM) and metastatic axilla (Group M). They were retrospectively evaluated for DNI, IG, white blood cell count (WBC), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and mean platelet volumes (MPV). Results: All of the 83 patients, who met the inclusion criteria, were females (100%). Forty-six patients (55.42%) were in the Group-NM and 37 (44.58%) were in Group-M. Statistically significant difference was observed between the groups in terms of WBC, NLR, PLR, MPV, DNI and IG count (p<0.05), while there was no difference in age (p = 0.862). As a result of the univariate and multivariate analysis, WBC, NLR, PLR, MPV, DNI and IG count were determined as predictive factors. The discriminatory power of the DNI for diagnosing clinically negative pathologically positive axillary metastasis of breast cancer at the cut-off value ≥0.35% (ARUC:0.903; 95% confidence interval [CI]: 0.84–0.967) showed 86.5% sensitivity, 80.4% specificity, positive predictive value (PPV) 86.5%, negative predictive value (NPV) 80.4%. The discriminatory power of the IG count for diagnosing clinically negative pathologically positive axillary metastasis of breast cancer, at the cut-off value ≥25/mm3 (ARUC:0.976; 95% CI:0.953–1.000) showed 100% sensitivity, 82.6% specificity, 100% PPV, and 82.6% NPV. Conclusion: DNI and IG count may be new predictive factors with high sensitivity and specificity in detecting axillary metastasis of breast cancer.