Diagnostic Utility of Neutrophil-to-Lymphocyte Ratio in Differentiating Benign and Malignant Ovarian Masses: A Systematic Review

TL;DR

This study finds that the neutrophil-to-lymphocyte ratio (NLR) can somewhat help tell apart benign and cancerous ovarian masses, but it's not reliable enough to use alone for diagnosis.

Contribution

The study systematically evaluates NLR's diagnostic utility for ovarian masses and highlights the need for better models combining blood markers with other clinical data.

Findings

Malignant ovarian masses had higher NLR values compared to benign masses.

NLR had moderate diagnostic performance with an AUC of 0.66.

The study found no statistically significant correlation between NLR and malignancy.

Abstract

Early and accurate separation of benign (non-cancerous) from malignant (cancerous) ovarian masses can improve referral decisions, reduce unnecessary surgery, and speed access to specialist care. Because a complete blood count is inexpensive and widely available, we examined whether the neutrophil-to-lymphocyte ratio (NLR; a measure of inflammation calculated from routine blood tests) can help distinguish these two conditions before surgery. We systematically reviewed the available evidence and combined results from eight studies including 3675 patients. Overall, malignant ovarian masses tended to have higher values of this ratio, but its ability to correctly classify masses was only moderate, suggesting it should not be used alone to guide diagnosis. These findings highlight the need for better risk models that combine blood-based markers with imaging and clinical features, and for future studies to standardize cut-off values and reporting.

Background/Objectives: Given its cost-effectiveness and availability, NLR could play a pivotal role in refining the diagnostic process. We aimed to evaluate whether NLR can serve as a useful marker to differentiate between benign and malignant ovarian masses, synthesizing available evidence to provide a comprehensive assessment of its diagnostic value. Methods: A comprehensive search was conducted across the following electronic databases: PubMed, Europe PMC, and SCOPUS on 4 January 2026. For inclusion, studies were required to report on the use of NLR as a biomarker for differentiating ovarian masses, involve human participants with preoperative measurements of these ratios, and provide data on diagnostic accuracy, such as sensitivity, specificity, or receiver operating characteristic (ROC) curves. Both retrospective and prospective observational studies were considered. Results: This systematic review incorporated data from 3675 patients across ten studies. The meta-analysis revealed that malignant masses exhibited a significantly elevated mean NLR (HR −0.80 [95% CI: −1.17 to −0.42]), but found no statistically significant correlation (OR 1.49 [95% CI: 0.67 to 3.30]). NLR had moderate diagnostic performance with an AUC of 0.66 (95% CI: 0.62–0.69). Conclusions: While malignant ovarian masses are associated with a significantly higher mean NLR, the overall diagnostic performance of NLR remains moderate, suggesting limited utility in distinguishing between benign and malignant tumors.

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