A New Diagnostic Approach Using the
NLR
/
LMR
Ratio in the Differential Diagnosis of Neck Masses: Hematologic Evaluation of Patients With Cervical L
Servet Erdemes, Gizem Ay Haldız, Müslüm Ayral, Ali Çetin ABSTRACT
Objective
To evaluate the diagnostic utility of hematologic ratios derived from routine complete blood count parameters in differentiating malignant, granulomatous, and reactive cervical lymphadenopathies, with a particular focus on the novel neutrophil‐to‐lymphocyte ratio to lymphocyte‐to‐monocyte ratio (NLR/LMR).
Methods
This retrospective study included 406 adult patients who underwent excisional cervical lymph node biopsy between 2015 and 2024 and had histopathologically confirmed diagnoses. Patients were classified into five groups: reactive lymphadenopathy, Hodgkin lymphoma (HL), non‐Hodgkin lymphoma (NHL), granulomatous non‐caseating (Gran–NC), and granulomatous caseating (Gran–C). Pre‐biopsy hematologic parameters (WBC, neutrophil, lymphocyte, monocyte, platelet, RDW) and derived ratios (NLR, LMR, PLR, RDW/PLT, NLR/LMR) were compared among groups. ROC curve analyses were used to assess the diagnostic performance of these parameters in distinguishing lymphoma from non‐lymphoma cases.
Results
WBC, neutrophil, monocyte, and RDW levels were significantly higher in lymphoma groups than in reactive and granulomatous groups ( p < 0.001). Among derived ratios, NLR, LMR, PLR, and NLR/LMR demonstrated significant intergroup differences ( p < 0.001). ROC analysis identified NLR (AUC = 0.702, cut‐off = 2.02, OR = 4.92) and NLR/LMR (AUC = 0.707, cut‐off = 0.81, OR = 4.59) as the strongest discriminators for lymphoma. Multivariate logistic regression confirmed both NLR (OR = 1.49, 95% CI 1.24–1.79, p < 0.001) and NLR/LMR (OR = 1.94, 95% CI 1.46–2.57, p < 0.001) as independent predictors of malignancy.
Conclusion
Simple hematologic ratios such as NLR and especially the combined index NLR/LMR can serve as reliable, low‐cost, and noninvasive diagnostic indicators for differentiating lymphoma from benign lymphadenopathies. Incorporating these ratios.