Diagnostic Value of Inflammatory Markers in Parotid Gland Tumors

Clinicians often face significant challenges when attempting to distinguish between benign and malignant parotid masses preoperatively. A recent retrospective study evaluated the diagnostic potential of various preoperative hematologic indices in identifying parotid gland tumor malignancy. Researchers analyzed data from 259 patients at the Necmettin Erbakan University Faculty of Medicine who underwent parotidectomy between 2020 and 2025. Interestingly, the results indicated that common inflammatory markers do not reliably predict malignancy in these patients. Consequently, the reliance on these systemic indices as standalone diagnostic tools remains limited in routine practice.

Evaluating Parotid Gland Tumor Malignancy

The study cohort included 101 patients with pleomorphic adenoma, 107 with Warthin’s tumor, and 51 with malignant tumors. Researchers calculated several indices, including the Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), and Systemic Immune-Inflammation Index (SII). However, the statistical analysis revealed no significant differences in these markers between benign and malignant groups. Specifically, none of the indices, including the Systemic Inflammation Response Index (SIRI) or the Wagener-Meir Ratio (WMR), demonstrated sufficient discriminative performance for parotid gland tumor malignancy. These findings suggest that systemic inflammation may not be a sensitive indicator for distinguishing primary parotid cancers from their benign counterparts.

Distinguishing Warthin’s Tumors from Other Masses

While the markers failed to predict malignancy, they did show significant variations in Warthin’s tumors. Furthermore, patients with Warthin’s tumors demonstrated significantly higher levels of white blood cells, neutrophils, lymphocytes, and monocytes compared to those with pleomorphic adenoma or malignant tumors. This elevation likely reflects the unique lymphoid component and inflammatory environment characteristic of Warthin’s pathology. Moreover, the Receiver Operating Characteristic (ROC) analysis confirmed that these hematologic parameters are more effective at identifying Warthin’s tumors than at distinguishing malignancy. Therefore, clinicians should interpret elevated inflammatory markers with caution, as they may point toward a specific benign subtype rather than cancer.

Clinical Implications for Otorhinolaryngologists

The study ultimately concludes that preoperative inflammatory markers lack the necessary sensitivity and specificity to replace gold-standard diagnostics like fine-needle aspiration cytology or advanced imaging. Additionally, the lack of correlation between systemic indices and malignancy suggests that localized tumor factors might play a more dominant role than systemic responses in parotid pathology. Surgeons should prioritize histopathological and radiological findings when planning surgical interventions. Meanwhile, ongoing research continues to investigate if combining these markers with imaging might improve overall diagnostic accuracy.

FAQ

Can NLR or SII distinguish between benign and malignant parotid tumors?

No, a recent retrospective study found that indices like NLR, PLR, and SII do not show significant differences between benign and malignant parotid tumors, making them unreliable for malignancy prediction.

Why are inflammatory markers higher in Warthin’s tumors?

Warthin’s tumors often exhibit higher inflammatory markers because they possess a significant lymphoid stroma. This unique histopathologic feature leads to higher circulating levels of neutrophils and lymphocytes compared to other parotid masses.

Should surgeons use these markers in routine clinical practice?

While these markers are cost-effective and easy to obtain, they should only be used as adjunctive data. They do not possess enough diagnostic power to independently distinguish malignancy from benign conditions in the parotid gland.

Disclaimer: This content is for informational and educational purposes only and does not constitute medical advice or a professional relationship. It is not intended to be a substitute for professional medical diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Refer to the latest local and national guidelines for clinical practice.

References

• Rukiye OE et al. Evaluation of Systemic Inflammatory Markers in Predicting Malignancy in Parotid Gland Tumors. Laryngoscope. 2026 Mar 23. doi: 10.1002/lary.70491. PMID: 41872070.


• Ikinciogullari A et al. Evaluation of Inflammatory Biomarkers in Parotid Tumors. Med Sci Monit. 2025 Aug 17:31:e947334. doi: 10.12659/MSM.947334. PMID: 40819210.


• Aslan M, Tan M. The uses of platelet indices, NLR (Neutrophil to Lymphocyte Ratio) and PLR (Platelet to Lymphocyte Ratio) in the predictive value diagnosis of benign and malignant masses of the parotid gland. Ann Med Res 2021;28(12):2224-30.