|Year : 2016 | Volume
| Issue : 2 | Page : 41-43
Red cell distribution width as a marker of thyroid papillary carcinoma
Baris Sevinc1, Omer Karahan2, Serden Ay3, Nergis Aksoy3, Ahmet Okus4
1 Department of General Surgery, Sarikaya State Hospital, Yozgat, Turkey
2 Department of General Surgery, Necmettin Erbakan University, Meram Medical School, Konya, Turkey
3 Department of General Surgery, Konya Training and Research Hospital, Konya, Turkey
4 Department of General Surgery, Medical Faculty, Mevlana University, Konya, Turkey
|Date of Submission||16-Dec-2015|
|Date of Acceptance||18-Mar-2016|
|Date of Web Publication||1-Jul-2016|
Department of General Surgery, Sar?kaya State Hospital, Osmangazi Mah., Sar?kaya, Yozgat 66650
Source of Support: None, Conflict of Interest: None
Aim: The study aims to evaluate the relation between red cell distribution width (RDW) and papillary thyroid carcinoma. RDW is a part of routine complete blood count which shows the heterogeneity of the circulating red cells. Studies showed that RDW increases in inflammatory disorders. Methods: The patients' data from 100 cases with total thyroidectomy were retrospectively evaluated. A total of 50 cases with thyroid papillary carcinoma and 50 cases with benign thyroid nodule were included into the evaluation. Results: The mean RDW value was 14.5 ± 1.7 in papillary carcinoma group and 13.4 ± 0.8 in benign thyroid nodule group. Other hematological parameters of the groups were similar. According to the receiver operating characteristic (ROC) curve, the optimal RDW value for thyroid papillary carcinoma was found to be 12.95% with a sensitivity of 88.00% and specificity of 70.00% (the area under an ROC curve: 0.718, P < 0.001). Conclusion: There is no study in literature evaluating the relation between RDW value and papillary thyroid carcinoma. According to the recent study, an increase in RDW value can be a helping parameter in differentiating papillary carcinoma from benign thyroid nodule.
Keywords: Benign thyroid nodule, papillary thyroid carcinoma, red cell distribution width
|How to cite this article:|
Sevinc B, Karahan O, Ay S, Aksoy N, Okus A. Red cell distribution width as a marker of thyroid papillary carcinoma. Transl Surg 2016;1:41-3
|How to cite this URL:|
Sevinc B, Karahan O, Ay S, Aksoy N, Okus A. Red cell distribution width as a marker of thyroid papillary carcinoma. Transl Surg [serial online] 2016 [cited 2019 Mar 22];1:41-3. Available from: http://www.translsurg.com/text.asp?2016/1/2/41/185198
| Introduction|| |
Red cell distribution width (RDW) is one of the parameters of standard complete blood count. It shows the heterogeneity of red cells in circulation. The clinical use of RDW was limited in differentiating anemia from microcytosis. However, recent studies showed increased RDW levels in atherosclerosis, ischemic heart failure, hypertension, inflammatory bowel disease, rheumatoid arthritis, and other inflammatory disorders. ,,,, Inflammation and oxidative stress affects the RDW value.  Moreover, RDW levels can show the levels of circulating cytokines such as interleukin 6, tumor necrosis factor-α (IL6, TNF-α), and hepsidin. ,
Although solid malignancies are characterized by chronic inflammation; the relation between RDW and malign tumors is less known. There are several studies reporting the relation between subclinical hypothyroidism and RDW values. , The aim of this study is to evaluate the relation between the RDW values and thyroid papillary carcinoma.
| Methods|| |
The study was conducted in Konya Training and Research Hospital. The data were retrospectively collected from the hospital records. The files of the patients who underwent total thyroidectomy were evaluated. Patients with anemia, other hematological disorders, active infection, blood transfusion or donation in last 3 months, past venous thrombosis, iron replacement, hypertension, heart failure, inflammatory bowel disease, and rheumatoid arthritis were excluded from the study.
A total of 100 cases were included in the study, with 50 cases of thyroid papillary carcinoma and 50 cases of benign thyroid diseases. Groups were generated according to histopathological examination results. Patients' demographics, histopathological evaluation reports, and complete blood count results were recorded.
Patients were divided into 2 groups as papillary carcinoma group and the control group (benign thyroid nodules). Hematological parameters of the 2 groups were compared.
The statistical analysis was performed using SPSS statistics 20.0 statistical package program (SPSS Software, IBM, USA). The data were presented as mean ± standard deviation. Categorical variables were presented as frequencies. For analysis, Student's t-test and Chi-square test were used, where appropriate. P < 0.05 was accepted as statistically significant. RDW values in predicting thyroid papillary carcinoma were analyzed using receiver operating characteristics (ROC) curve analysis. When a significant cut-off value was observed, the sensitivity and specificity were presented.
| Results|| |
There were 100 cases included in the study, with 50 cases suffering from thyroid papillary carcinoma (Group 1) and 50 cases with benign thyroid nodule (Group 2). The mean age of the patients was 49.8 ± 12.7. There were 21 males and 79 females in the study. The demographics of the patients are shown in [Table 1].
In Group 1, the mean RDW value was 14.5 ± 1.7 in Group 1 and 13.4 ± 0.8 in Group 2. The difference was statistically significant (P < 0.001). No difference in terms of hemoglobin (Hb) levels, mean corpuscular Hb levels, and platelet counts were observed between the groups [Table 2]. According to the ROC curve, the optimal RDW value for thyroid papillary carcinoma was found to be 12.95% with a sensitivity of 88.00% and a specificity of 70.00% (the area under an ROC curve [AUC]: 0.718, P < 0.001) [Figure 1].
|Figure 1: Receiver operating characteristics curve for red cell distribution width (the area under an ROC curve: 0.718, P < 0.001). ROC: Receiver operating characteristics; RDW: Red cell distribution width; AUC: The area under an ROC curve|
Click here to view
|Table 2: Hemoglobin, mean corpuscular volume, and red cell distribution width values|
Click here to view
| Discussion|| |
In several autopsy surveys, the incidence of thyroid nodules was found to be 35-57%. , In nonsurgical series, thyroid malignancy was found in 4.00-6.50% of all thyroid nodules. ,,,, In a report based on the SEER database from 1973 to 2002, the incidence of papillary thyroid carcinoma increased from 2.7 to 7.7 per 100,000, a 2.9-fold increase (95.00%, confidence interval: 2.6-3.2). 
In papillary carcinoma, chronic anemia is not an expected finding. In this study, we tried to evaluate if there can be a relation between the RDW value and thyroid papillary carcinoma. RDW as a parameter of routine complete blood count shows the anisocytosis of the circulating red blood cells. Recent studies showed increased RDW levels in atherosclerosis, ischemic heart failure, hypertension, inflammatory bowel disease, rheumatoid arthritis, and other inflammatory disorders. ,,,, RDW is an early detector of oxidative stress, disorders of iron mobilization, and iron deficiency anemia. Moreover, its correlation with inflammatory markers such as c-reactive protein (CRP), IL6, and TNF-α is shown in many studies. , Furthermore, Lippi et al.  showed that its increase correlated with erythrocyte sedimentation rate and CRP levels in inflammation. In 2 different studies, beneficial use of RDW value in the detection of colorectal cancers was reported. Both studies concluded as RDW can be used as a parameter in the early detection of colorectal cancer. , Beyazit et al.  reported RDW as a useful parameter in the differentiation of benign and malignant disorders causing biliary obstruction with a 14.80% cut-off point (72.00% sensitivity and 69.00% specificity). Moreover, Seretis et al.  reported that RDW values increase in malignant breast lesions. In a retrospective study, Bashir et al.  evaluated 600 cases. They found increased levels of hematological parameters such as Hb, red blood cell (RBC), mean corpuscular volume, HCT, RBC%, and RDW in thyroid dysfunction patients, which suggests that abnormal levels of thyroid hormones might substantially influence the size variability of circulating RBC's, predisposing patients to normocytic anemia. Similarly, in a large scale population-based study with 23,343 cases, Yu et al.  reported a relation between RDW and subclinical hypothyroidism.
Aktas et al. reported that there is a relation between increased RDW and Hashimoto thyroiditis.
In literature, there is only one study evaluating the relation between RDW and thyroid nodule malignancy.  In a retrospective study by Kayilioglu et al.,  they evaluated different hematological parameters for malignancy. They found a strong relation between RDW and malignancy risk and reported the sensitivity of RDW as 52.78%, specificity as 74.63%, PPV as 52.78%, and NPV as 74.63% with a cut-off point of 14.1. Similarly, our study showed the relation between RDW and thyroid malignancy.
In papillary carcinoma group, the mean RDW value was significantly higher. According to the ROC curve, the optimal RDW value for thyroid papillary carcinoma was found to be 12.95% with a sensitivity of 88.00% and a specificity of 70.00% (AUC: 0.718, P < 0.001). The data from the current study state that RDW value can be useful in differentiating papillary carcinoma from benign thyroid nodule.
In the differentiation of benign and malignant thyroid nodules, RDW value can be used as a helping parameter. However, this is the first study to show the relation, and larger prospective studies are needed to show this relation.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Gunebakmaz O, Kaya MG, Duran M, Akpek M, Elcik D, Eryol NK. Red blood cell distribution width in ′non-dippers′ versus ′dippers′. Cardiology
Nishizaki Y, Yamagami S, Suzuki H, Joki Y, Takahashi S, Sesoko M, Yamashita H, Kuremoto K, Shinozaki T, Daida H. Red blood cell distribution width as an effective tool for detecting fatal heart failure in super-elderly patients. Intern Med
Karabulut A, Uzunlar B. Correlation between red cell distribution width and coronary ectasia in the acute myocardial infarction. Clin Appl Thromb Hemost
Yeþil A, Senateþ E, Bayoðlu IV, Erdem ED, Demirtunç R, Kurdaþ Övünç AO. Red cell distribution width: A novel marker of activity in inflammatory bowel disease. Gut Liver
Lee WS, Kim TY. Relation between red blood cell distribution width and inflammatory biomarkers in rheumatoid arthritis. Arch Pathol Lab Med
Patel KV, Semba RD, Ferrucci L, Newman AB, Fried LP, Wallace RB, Bandinelli S, Phillips CS, Yu B, Connelly S, Shlipak MG, Chaves PH, Launer LJ, Ershler WB, Harris TB, Longo DL, Guralnik JM. Red cell distribution width and mortality in older adults: A meta-analysis. J Gerontol A Biol Sci Med Sci
de Gonzalo-Calvo D, de Luxán-Delgado B, Rodríguez-González S, García-Macia M, Suárez FM, Solano JJ, Rodríguez-Colunga MJ, Coto-Montes A. Interleukin 6, soluble tumor necrosis factor receptor I and red blood cell distribution width as biological markers of functional dependence in an elderly population: A translational approach. Cytokine
Rhodes CJ, Howard LS, Busbridge M, Ashby D, Kondili E, Gibbs JS, Wharton J, Wilkins MR. Iron deficiency and raised hepcidin in idiopathic pulmonary arterial hypertension: Clinical prevalence, outcomes, and mechanistic insights. J Am Coll Cardiol
Bashir H, Bhat MH, Farooq R, Majid S, Shoib S, Hamid R, Mattoo AA, Rashid T, Bhat AA, Wani HA, Masood A. Comparison of hematological parameters in untreated and treated subclinical hypothyroidism and primary hypothyroidism patients. Med J Islam Repub Iran
Yu HM, Park KS, Lee JM. The value of red blood cell distribution width in subclinical hypothyroidism. Arq Bras Endocrinol Metabol
Rice CO. Incidence of nodules in the thyroid: A comparative study of symptomless thyroid glands removed at autopsy and hyperfunctioning goiters operatively removed. Arch Surg
Mortensen JD, Woolner LB, Bennett WA. Gross and microscopic findings in clinically normal thyroid glands. J Clin Endocrinol Metab
Werk EE Jr., Vernon BM, Gonzalez JJ, Ungaro PC, McCoy RC. Cancer in thyroid nodules. A community hospital survey. Arch Intern Med
Belfiore A, Giuffrida D, La Rosa GL, Ippolito O, Russo G, Fiumara A, Vigneri R, Filetti S. High frequency of cancer in cold thyroid nodules occurring at young age. Acta Endocrinol (Copenh)
Hegedüs L. Clinical practice. The thyroid nodule. N Engl J Med
Lin JD, Chao TC, Huang BY, Chen ST, Chang HY, Hsueh C. Thyroid cancer in the thyroid nodules evaluated by ultrasonography and fine-needle aspiration cytology. Thyroid
Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973-2002. JAMA
Agarwal S. Red cell distribution width, inflammatory markers and cardiorespiratory fitness: Results from the National Health and Nutrition Examination Survey. Indian Heart J
Lippi G, Targher G, Montagnana M, Salvagno GL, Zoppini G, Guidi GC. Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients. Arch Pathol Lab Med
Spell DW, Jones DV Jr., Harper WF, David Bessman J. The value of a complete blood count in predicting cancer of the colon. Cancer Detect Prev
Speights VO, Johnson MW, Stoltenberg PH, Rappaport ES, Helbert B, Riggs MW. Complete blood count indices in colorectal carcinoma. Arch Pathol Lab Med
Beyazit Y, Kekilli M, Ibis M, Kurt M, Sayilir A, Onal IK, Purnak T, Oztas E, Tas A, Yesil Y, Arhan M. Can red cell distribution width help to discriminate benign from malignant biliary obstruction? A retrospective single center analysis. Hepatogastroenterology
Seretis C, Seretis F, Lagoudianakis E, Gemenetzis G, Salemis NS. Is red cell distribution width a novel biomarker of breast cancer activity? Data from a pilot study. J Clin Med Res
Aktas G, Sit M, Dikbas O, Tekce BK, Savli H, Tekce H, Alcelik A. Could red cell distribution width be a marker in Hashimoto′s thyroiditis? Exp Clin Endocrinol Diabetes
Kayilioglu SI, Dinc T, Sozen I, Senol K, Katar K, Karabeyoglu M, Tez M, Coskun F. Thyroid nodules with atypia or follicular lesions of undetermined significance (AUS/FLUS): Analysis of variables associated with outcome. Asian Pac J Cancer Prev
[Table 1], [Table 2]