Is the neutrophil-to-lymphocyte "ratio"nale from head and neck to thyroidology for thyroidologists?: promise or passé?

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Dear Editor,

We read with a great deal the research article entitled "Is the neutrophil-to-lymphocyte ratio a marker for differentiating between benign and malignant submandibular gland masses?" by Bora^ 1 ^. This research of high quality seems to demand portraying to evaluation of the effect of the neutrophil-to-lymphocyte ratio (N/L) on distinguishing benign from malignant masses in the submandibular triangle of the head and neck which has recently been published in the 69th volume of Rev Assoc Med Bras ^ 1 ^. The author stated that he retrospectively evaluated 48 cases who had undergone surgery for submandibular gland masses with the histopathology of sialolithiasis, sialadenitis, pleomorphic adenoma^ 2–4 ^, and malignant conditions. He deduced and emphasized that N/L, per se, can be used as a biomarker in submandibular gland masses and has prognostic significance in malignant masses. Moreover, he proposed that N/L can be utilized as a biomarker beyond fine needle aspiration cytology. Thereto, he highlighted N/L as being proven in distinguishing between benign and malignant nodules in patients^ 1 ^ with suspicious thyroid nodules^ 1,5–17 ^. Nevertheless, at least a minimal debate is still ongoing on an accurate decision on N/L whether it is a biomarker in discrimination of malignity or not. Exempligratia, we reported that N/L was not a convenient and favorable biomarker in forecasting thyroid malignancy^ 18 ^ in thyroidology^ 19–29 ^. Of note, N/L, particularly in the thyroid with head and neck providers, the growing spectrum of clinical management for challenging conditions remains, especially for thyroidologists and thyroid health as different peas in a pod. Fide, sed cui vide. As a matter of fact, this issue merits further investigation. We thank Bora^ 1 ^ for his valuable study.