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

Abstract

<h4>Background/objectives</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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).<h4>Conclusions</h4>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.