Neutrophil-lymphocyte Ratio: Predictor of High-grade Dysplasia in Colorectal Polyp

ABSTRACT Objective: To determine the value of neutrophil-lymphocyte ratio for predicting high-grade dysplasia among patients with neoplastic colorectal polyp. Method: We evaluated 30 patients with non-neoplastic polyp, 61 patients with neoplastic polyp (32 with high-grade dysplasia/29 without high-grade dysplasia), and 30 patients with normal colonoscopy as control group. Mean platelet volume, red cell distribution width, neutrophil and lymphocyte levels were recorded and neutrophil-lymphocyte ratio was calculated. Results: Mean neutrophil-lymphocyte ratio of patients with neoplastic polyp were higher than patients with non-neoplastic polyp and control group (2.56 ± 1.47, 1.77 ± 0.44, 1.76 ± 0.62, retrospectively) (p = 0.001). Mean platelet volume of patients with neoplastic polyp (8.76 ± 1.06) was lower than patients with non- neoplastic polyp (9.50 ± 1.27) and control group (10.96 ± 0.83) (p < 0.001). Mean neutrophil-lymphocyte ratio of patients with high-grade dysplasia (3.03 ± 1.88) was significantly higher than patients without high-grade dysplasia (2.14 ± 0.77) (p = 0.022). The cut-off value of neutrophil-lymphocyte ratio to predict the presence of high-grade dysplasia was 2.044 (sensitivity: 69%, specificity: 68%). Conclusion: Neutrophil-lymphocyte ratio, which is a simple non-invasive index can predict high-grade dysplasia and neoplastic polyp. Although mean platelet volume and red cell distribution width are not useful for identifying high-grade dysplasia in patients with colorectal polyp, mean platelet volume may be associated with neoplastic polyp.

Pólipo difícil. Enfoque y manejo / How to approach and manage difficult polyps

Ante la pregunta: ¿Cuándo se debe remover un pólipo? ¡Siempre!, así de enfática debe ser la respuesta, después de que estos adquirieron tanta importancia como responsables en gran parte de la génesis del cáncer colorrectal. El 80% son adenomas y de acuerdo al tamaño, especialmente los mayores de 20 mm, tienen un mayor riesgo de malignidad, aunque globalmente solo 5-10% pueden generar un cáncer. En este escrito pretendemos de una manera práctica presentar la mejor manera de abordar un pólipo considerado como difícil, de acuerdo a sus características morfológicas como tamaño, tipo, morfología, cantidad, localización y una serie de estrategias para su resección. La polipectomía es uno de los principales avances de la medicina en el siglo XX, ya que en manos experimentadas es muy seguro, altamente efectivo (90-97%) y con una disminución comprobada en la incidencia de cáncer colorrectal de un 80%.

If asked when to remove a polyp, the answer should always be ALWAYS! The answer became this emphatic after polyps acquired such importance because they are largely responsible for the genesis of colorectal cancer. 80% of polyps are adenomas which have risks of malignancy which increase as their size increases. This risk is especially high when they are larger than 20 mm. Nevertheless, overall only 5% to 10% generate cancer. In this paper we intend to present the best practical approach and a range of strategies for resection for polyps considered to be difficult because of their morphological characteristics such as size, type, morphology, quantity and location. Polypectomy is a major medical advance of the twentieth century. In experienced hands, it is very safe, highly effective (90-97%) and decreases incidence of proven colorectal cancer by 80%.