Evaluation of the predictive role of neutrophil/lymphocyte ratio in the diagnosis of lymphoma in patients with asymptomatic and ısolated cervical lymphadenopathy

Mehmet Erkan Kaplama, Ahmet Kürşad Güneş, Burak Erden, Evaluation of the predictive role of neutrophil/lymphocyte ratio in the diagnosis of lymphoma in patients with asymptomatic and ısolated cervical lymphadenopathy, Brazilian Journal of Otorhinolaryngology, Volume 87, Issue 2, 2021, Pages 210-216, ISSN 1808-8694, https://doi.org/10.1016/j.bjorl.2020.06.012.(https://www.sciencedirect.com/science/article/pii/S1808869420301129)

I chose to present this article in conjunction with my case presentation of an 18-year-old girl with cervical lymphadenopathy as one of my differentials for this patient was lymphoma.  The objective of this article was to determine the predictive value of the neutrophil:lymphocyte ratio in the diagnosis of Hodgkin and non-Hodgkin lymphoma in patients with otherwise asymptomatic cervical lymphadenopathy who had undergone excisional biopsy. Excisional biopsies of cervical lymphadenopathy are done to differentiate lymphoma from reactive lymph nodes from infectious causes. Excisional biopsies are not without complications, and so if predictive tools can be used to avoid this procedure it would be of value.

This study included a total of 90 patients with isolated asymptomatic cervical lymphadenopathy that had been present for at least 4 weeks. All of these patients underwent excisional biopsy. 34 were diagnosed with reactive lymphadenopathy, 30 with non-hodgkin lymphoma, and 26 with Hodgkin lymphoma. In the lymphoma group the median age, total white blood cell count, and neutrophil count were significantly higher than the reactive lymphadenopathy group. Lymphocyte count was significantly lower in the reactive lymph node group.  The median neutrophil: lymphocyte ratio in the reactive lymphadenopathy group was 1.7, 3.5 in the Non-Hodgkin group, and 3.0 in the Hodgkin group. They concluded that neutrophil:lymphocyte ratio has a predictive value in the diagnosis of lymphoma in patients with asymptomatic lymphadenopathy.

There are limitations to this study. It is retrospective designed, it has a small number of participants , so more studies should be done with larger groups. Additionally it was a single center study. Prospective studies should be done with larger groups and multiple centers to support the conclusion of the predictive value of neutrophil:lymphocyte ratio in diagnosing lymphoma.

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