Is there a threshold for red cell distribution width to predict malignancy in breast masses?

Background

Red cell distribution width (RDW) has been shown to have predictive properties in different diseases as well as solid cancers.

Aim

We aimed to investigate the discriminative properties of RDW in benign and malignant breast lesions.

Subjects and Methods

In a retrospective cohort study the files of patients who underwent surgery for fibroadenomas (Group A) and breast cancer with axillary lymph node metastasis (Group B) were reviewed. The pathology reports and laboratory parameters and demographics of the patients were recorded for comparison. The patients were later excluded if they had an hemoglobin level below 12 mg/dl and the outliers were removed for a comparison. Seventy-six patients in the fibroadenoma group and 62 patients in the breast malignancy group were compared for the RDW levels to predict the presence of malignancy. Receiver operating characteristic curves were plotted for RDW and a threshold for prediction of malignancy was calculated.

Results

The difference in RDW levels between group A and group B was found to be significant, 13,10% (IQR 12.60 -13.70) versus 13,80% (IQR 13.10-14.40) respectively, P = 0,00. The area under the curve was 0.71 (95% confidence interval 0.62 to 0.79), P = 0,00. For the threshold of 13,75 the positive predictive value was 67.35 (95% CI 55.72 to 77.17) and negative predictive value was 67.42 (95% CI 60.76% to 73.44).

Conclusion

The RDW levels, after adjusted for anemia, were found to have a positive prediction for malignancy in more than two thirds of the patients for the level of 13.75%.

Preoperative appendix diameter obtained by computerized tomography scanning predicts conversion from laparoscopic to open appendectomy

Background

Open appendectomy (OA) has been the gold standard for a long time. Laparoscopic appendectomy (LA) has gained wide acceptance and popularity, outdoing open approach. Yet, conversion may be required when laparoscopic approach fails.

Aims

To predict conversion from laparoscopic appendectomy to open appendectomy sing Oreo-ratio radiological appendices diameter.

Materials and Methods

This is a retrospective cohort study conducted on 320 (included) patients who underwent appendectomy between January 2018 and August 2018 in the General Surgery departmentof Haseki Training and Research Hospital, Istanbul, Turkey. Appendiceal diameter obtained during preoperative radiological screening was evaluated about its relationship to conversion from LA to OA. Age, sex, inflammatory serum parameters and pathology reports were also investigated.

Results

A total of 269 (84%) cases were started LA and 17 (6,3%) laparoscopic cases were converted to open. The appendix diameter, the grade of inflammation (perforated or gangrenous), age, and c-reactive protein (CRP) were found to have significant importance in conversion, P = 0.003, P = 0.000, P = 0.042, and P = 0.018, respectively. When a cutoff of 50 years was chosen for age, the odds ratio (OR) was 3. For the appendiceal diameter of 14 mm, the OR was 3.0286.

Conclusion

Preoperative evaluation of appendix diameter is a quick and useful method for a surgeon to distinguish cases with risk of conversion in the emergency department. The other risk factors associated with conversion of LA to OA are grade of inflammation, age and CRP levels.

The discriminative properties of erythrocyte anisocytosis in patients with resectable malignant pancreatic masses compared with an age and gender matched control group

INTRODUCTION

Red cell distribution width (RDW) is a parameter that reflects the heterogeneity in the size of the circulating erythrocytes. Elevated levels of RDW have been found related to various pathologic conditions including cancers. We hypothesized that elevated RDW levels might correspond to advanced stages of pancreatic cancer.

METHODS

The medical files and pathology reports of patients who underwent Whipple procedure were evaluated in a retrospective casecontrol study. The relationship of RDW to age, gender, cancer antigen 19-9 (CA 19-9), blood hemoglobin levels, stage of the tumor, tumor size, tumor grade, number of lymph nodes with metastasis, the status of lymphovascular and perineural invasion were investigated. A oneto-two, age- and- gender matched group of seemingly healthy patients was used to compare the levels of RDW between the patients of pancreatic head malignancy and healthy people. ROC (receiver operating characteristics) curves analysis was conducted to define a threshold to discriminate malignant pancreatic head tumors from healthy control subjects. Then, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (+LR), and negative likelihood ratio (-LR) were calculated.

RESULTS

The median age was 61 years (IRQ 54.75-69). The median RDWs were 15.20% (IQR 13.20-19.50) vs 13.00 (IQR 12.60-13.48) in the pancreas adenocancer and the control group, respectively, p=0.000). There was significant relationship between RDW and the grade of the tumor, p=0.026. An RDW level of 14% was obtained as a result of the ROC curves analysis and the positive predictivity about malignancy was 70.73% with a negative predictive rate of 89.95% compared with the healthy group of patients.

CONCLUSION

The elevated levels of RDW in patients with a pancreatic mass may point to a possible malignancy; however, an elevated RDW in a patient with a malignant pancreatic head mass is related to the grade of the disease, not the stage.