ArticleJournal of clinical laboratory analysis2026
A New Diagnostic Approach Using the NLR/LMR Ratio in the Differential Diagnosis of Neck Masses: Hematologic Evaluation of Patients With Cervical Lymphadenopathy.
Article in Journal of clinical laboratory analysis, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo 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).
methodsThis 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.
resultsWBC, 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.
conclusionSimple 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.
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