The role of immature granulocyte ratio in predicting dysplastic colon polyps

Authors

Abstract

AimDysplastic colorectal polyps, especially those with high-grade dysplasia, have a significant risk of malignant transformation. Immature granulocytes (IGs), markers of systemic inflammation, have shown prognostic value in various inflammatory and malignant diseases, but their role in colorectal polyp dysplasia is unclear. This study investigated the association between IG count and percentage and the histopathological features of colorectal polyps, and evaluated the predictive value of IG parameters for dysplasia.
MethodsThis retrospective study included patients aged ≥18 years who underwent colonoscopy and were diagnosed with colorectal polyps. Demographic data, laboratory parameters, and colonoscopic and histopathological findings were analyzed. Polyps were classified according to dysplasia grade, neoplastic status, and morphology (sessile or pedunculated). The immature granulocyte count and percentage were compared between groups using appropriate statistical tests.
ResultsA total of 144 patients were included, 123 (85.4%) with low-grade dysplasia and 21 (14.6%) with high-grade dysplasia. There were no statistically significant differences in immature granulocyte count or percentage between the low- and high-grade dysplasia groups. Similarly, IG parameters did not differ significantly according to neoplastic status or polyp morphology (sessile vs. pedunculated). No association was identified between IG values and the histopathological characteristics of colorectal polyps.
ConclusionThe immature granulocyte count and percentage do not appear to have predictive value in determining dysplasia grade, neoplastic status, or morphological features of colorectal polyps. These findings suggest that IG parameters may not be useful biomarkers for predicting dysplasia in colorectal polyps.

Keywords

Introduction

Dysplastic colon polyps, especially those with high-grade dysplasia, pose significant concerns regarding morbidity and mortality owing to their potential to harbor invasive malignancies or progress. The detection and management of these polyps have advanced with sophisticated screening programs aimed at limiting procedural morbidity while addressing the risk of occult lymph node metastasis .¹ Various endoscopic techniques, such as mucosal resection and submucosal dissection, have been developed to manage low-risk lesions and reduce surgical morbidity . The incidence of colon polyps increases with age and is more frequently detected in Western cities. In the United States, the prevalence is 30% in people over 50 years of age and 6% in children.^2,3 However, high-grade dysplasia and polyp location distant from splenic torsion are significant predictors of cancer risk. In such cases, with a 43% incidence of occult cancer, these polyps may not be suitable for less-invasive procedures during the learning curve of laparoscopic surgery.⁴ The management of serious dysplastic non-pedunculated lesions usually requires surgical intervention, as endoscopic sampling can be misleading, and these lesions must be treated with the same rigor as invasive cancers.⁵ In this study, we aimed to investigate the systemic effects of the inflammatory nature of dysplastic polyps and their relationship with immature granulocytes (IG), which are known to be early markers of inflammation in peripheral blood.

Materials and Methods

Patients who underwent colonoscopy at our center and were diagnosed with polyps were included in this study. A comprehensive review of the patients' medical records was conducted to obtain demographic information, medical history, laboratory results, and colonoscopy findings. Specifically, immature granulocyte percentage (IG%) levels and polyp findings were determined.
Polyp EvaluationThe evaluation of polyps will be conducted in accordance with several parameters, including size, numerical quantity, histological classification, and the presence of dysplasia. The presence and degree of dysplasia will be assessed by a pathologist.
Patients over the age of 18 years who underwent colonoscopic evaluation at our center were included in the study, while patients in whom no polyps were detected during colonoscopy and whose pathological status could not be monitored were excluded.
Ethical ApprovalThis study was approved by the Ethics Committee of Akdeniz University Faculty of Medicine Clinical Research (Date: 07.06.2023, Decision No: KAEK-459).
Statistical AnalysisThe results of the study were evaluated using the Statistical Package for the Social Sciences (SPSS) for Windows, version 27.0, a program designed for statistical analysis. GraphPad Prism 9 software (Boston, MA) was used to graph the data collected in the study. Subsequently, the data were classified. Categorical data were defined as percentages and frequencies. Numerical data were defined, and a distribution analysis was performed. Data following a normal distribution were defined as the mean ± standard deviation (SD). In instances where the data did not conform to a normal distribution, the median and interquartile range (IQR) were defined. The chi-square test was used to ascertain the relationship between the categorical data. The t-test was used to assess data that followed a normal distribution, while the Mann-Whitney U test was used to evaluate data that did not follow a normal distribution. Statistical findings with a p-value below 0.05 were considered to be significant.
Reporting GuidelinesThis study was reported in accordance with the STROBE guidelines.

Results

The study sample population comprised 144 patients. Of the patients in this study, 123 (85.4%) exhibited low-grade dysplasia and 21 (14.6%) demonstrated high-grade dysplasia. Table 1 presents the descriptive statistics. The mean hemogram value was 13.71 ± 1.73 in cases of low dysplasia and 13.54 ± 1.91 in cases of high dysplasia, with no statistically significant difference observed between the two groups (p = 0.285). Table 2 presents a comparison of the biochemical values.
In the comparison based on the patients' neoplastic status, the median immature value for non-neoplastic patients was 0.02 (0.02-0.05), while the median value for neoplastic patients was 0.02 (0.01-0.04). No significant difference was observed between the two groups (p = 0.925, Figure 1a). For the IG percentile value, the median value was 0.3 (0.23-0.58) for non-neoplastic patients and 0.3 (0.2-0.5) for neoplastic patients, and no significant difference was observed between them (p = 0.110, Figure 1b).
The median IG count for sessile polyps was 0.02 (0.02–0.04), while the median IG count for pedunculated polyps was 0.02 (0.01–0.06), and no significant difference was observed between them (p = 0.406, Figure 1c). The median IG percentage for sessile polyps was 0.3 (0.2–0.4), while the median IG percentage for pedunculated polyps was 0.3 (0.2–0.5), and no significant difference was observed between them (p = 0.441, Figure 1d).

Discussion

Predictive factors for dysplasia in colon polyps include patient demographics, polyp characteristics, and histological features, and are multifactorial. Age is a consistent predictor in various studies; older patients show a higher prevalence of dysplasia in both pseudopolypoid lesions associated with inflammatory bowel disease (IBD) and sessile serrated lesions (SSLs) in the proximal colon. Polyp size is another critical factor; larger polyps, particularly pseudopolyps >5 mm and SSLs >10 mm, are more likely to exhibit dysplasia. Polyp location also plays an important role, with right-sided colonic pseudopolyps and proximal SSLs being more prone to dysplastic changes..^6,7 The presence of villous components and histological features such as high-grade dysplasia are strong indicators of malignant transformation, emphasizing the need for comprehensive histopathological examination. Additionally, the presence of multiple polyps and synchronous polyps, especially those with high-grade dysplasia or adenocarcinoma, increases the risk of dysplasia in other polyps.^8,9 Sex differences have been noted, with male patients having a higher likelihood of developing adenomas, but high-grade dysplasia is more common in women. The presence of hyperplastic polyps is associated with an increased risk of adenomas, suggesting that they may be a potential marker for neoplastic evolution.¹⁰
IG, a type of myeloblast, is a young cell that has not yet matured into granulocytes. It appears to be a biomarker for various diseases in peripheral blood measurements. IG has emerged as an important predictive marker for various medical conditions and has demonstrated benefits in both diagnostic and prognostic contexts. In the field of acute myocardial infarction (AMI), IG levels have shown a high predictive value for short-term mortality with an area under the curve (AUC) of 0.841, demonstrating their effectiveness in predicting death shortly after the event, despite being less effective for long-term mortality predictions .¹¹ Similarly, in acute pancreatitis, Ig levels serve as an independent risk factor for persistent systemic inflammatory response syndrome (SIRS) with an AUC of 0.806 and perform better than other markers, such as APACHE II and CRP, in predicting persistent SIRS.¹² In surgical settings such as cardiac surgery, the percentage of IG (IG%) has been useful in distinguishing between sepsis and non-infectious SIRS, with a predictive ability comparable to that of procalcitonin (PCT).¹³ Additionally, in the diagnosis of acute complicated appendicitis, the IG count and percentage were found to have significant predictive value for early diagnosis, with AUC values of 0.796 and 0.693, respectively.¹⁴ In breast cancer, the IG count has demonstrated high sensitivity and specificity in detecting axillary metastasis, with an AUC of 0.976, suggesting its potential as a noninvasive diagnostic tool.¹⁵ Additionally, in pediatric respiratory syncytial virus bronchiolitis cases, Ig% has been effective in predicting the need for intensive care, with an AUC of 0.730, and has emphasized its role in assessing disease severity.¹⁶ In acute cholecystitis, it has been demonstrated that the status of Ig levels predicts the condition with reasonable sensitivity and specificity and further supports its diagnostic benefits in emergency situations.¹⁷ Finally, in the context of upper gastrointestinal bleeding, IG% was a strong predictor of in-hospital mortality with an AUC of 0.98, highlighting its prognostic importance in critical care scenarios.¹⁸ Along with these, it has been observed that it is a mortality predictor due to the effect of inflammation developing after intrascerebellar hemorrhage and is used in the differentiation of peptic ulcer patients in the emergency department.^19,20
In our study, the characteristic structure of IG in colon polyps was analyzed. It was observed that it did not play an effective role in determining the neoplastic structure of patients, identifying the polyp type, or distinguishing between pedunculated and sessile polyps.
The immature granulocyte structure, it causes a right shift in cases of inflammation, such as trauma, infection, and chronic inflammation. However, as observed in previous studies, it provides information about the characteristics of the disease, mortality, and morbidity as a prognostic determinant. However, as seen in our study, there was no difference in systemic involvement among the types of colon polyps. Furthermore, no descriptive feature was observed in either the numerical or percentage comparison of IG. This is thought to be due to the lack of effective changes in the inflammatory state.

Limitations

This study has several limitations. First, due to its retrospective and single-center design, causal relationships cannot be established, and the generalizability of the findings is limited. Second, the relatively small sample size may have reduced the statistical power, particularly in subgroup analyses. Third, immature granulocyte (IG) levels were assessed at a single time point; therefore, dynamic changes in the inflammatory response could not be evaluated. In addition, other systemic inflammatory indices (such as SII, PIV, and SIRI) were not included in the analysis, which may have restricted a more comprehensive assessment of the systemic inflammatory status. Future prospective multicenter studies with larger patient populations, serial IG measurements, and integrated inflammatory indices are needed to confirm and extend our findings.

Conclusion

Although immature granulocytes have no predictive value for identifying colon polyps, they do not produce a significant difference between sessile and pedunculated polyps.

Declarations

Abbreviations

AMI: acute myocardial infarction
AUC: area under the curve
CRP: C-reactive protein
IG: immature granulocyte
IG%: immature granulocyte percentage
IBD: inflammatory bowel disease
IQR: interquartile range
PCT: procalcitonin
SD: standard deviation
SII: systemic immune-inflammation index
SIRI: systemic inflammation response index
SIRS: systemic inflammatory response syndrome
SPSS: Statistical Package for the Social Sciences
SSL: sessile serrated lesion

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About This Article

Received:

January 13, 2026

Accepted:

April 16, 2026

Published Online:

April 16, 2026