Use of neutrophil/lymphocyte ratio (NLR) and lymphocyte/monocyte ratio (LMR) as biomarkers in the differential diagnosis of malignant solitary pulmonary nodules NLR and LMR for lung nodules

Main Article Content

Murat Kuru
Tamer Altinok


Objective: Histopathological diagnosis of atypical lung nodules is often not possible in the preoperative period. This study evaluates the diagnostic value of neutrophil/lymphocyte ratio (NLR) and lymphocyte/monocyte ratio (LMR) as biomarkers in the differentiation of undiagnosed lung nodules.

Material and Methods: The study includes 91 patients (21 females, 70 males, mean age: 59.35 ± 11.85, age interval 20-81) operated on for lung nodules between September 2010 and September 2020. Age, gender, type of operation performed, histopathological type of the tumor, nodule size, SUVmax values measured on PET-CT, preoperative neutrophil/lymphocyte, and lymphocyte/monocyte ratios were analyzed retrospectively. These values were compared in patients with primary lung cancer (Group 1) and patients with secondary lung cancer, that is, patients with lung metastases from other organs (Group 2).

Results: NLR was statistically significantly higher in group 2 patients (N: 37)(3.38 ± 2.03). There was no statistically significant difference between the two groups in terms of LMR.

Conclusion: For lung nodules with unknown histopathological diagnosis, NLR values lower than 1.69 in preoperative complete blood count suggest primary lung cancer, and values above 2.92 suggest metastasis from other organs to the lung.


Download data is not yet available.

Article Details

How to Cite
Kuru, M., & Altinok, T. (2022). Use of neutrophil/lymphocyte ratio (NLR) and lymphocyte/monocyte ratio (LMR) as biomarkers in the differential diagnosis of malignant solitary pulmonary nodules: NLR and LMR for lung nodules. Medical Science and Discovery, 9(2), 121–125.
Research Article
Received 2022-01-20
Accepted 2022-02-10
Published 2022-02-21


Kartaloğlu Z. Approach to solitary pulmonary nodules. Turkish J Thorac Cardiovasc Surg.2008;16(4):274-283.

Vlahos I, Stefanidis K, Sheard S, Nair A, Sayer C, Moser J. Lung cancer screening: nodule identification and characterization. Transl Lung Cancer Res. 2018;7(3):288-303 DOI:

Kumar R, Geuna E, Michalarea V, Guardascione M, Naumann U, Lorente D et al. The neutrophil-lymphocyte ratio and its utilisation for the management of cancer patients in early clinical trials. Br J Cancer 2015;112:1157-65. DOI:

Yu Y, Qian L, Cui J. Value of neutrophil-to-lymphocyte ratio for predicting lung cancer prognosis: A meta-analysis of 7,219 patients. Mol Clin Oncol 2017;7(3):498-506. DOI:

Wang Y, Huang D, Xu W.Y., Wang Y.W, Che G.W. Small Cell Lung Cancer: A Meta-Analysis. Oncol Res Treat 2019;42:523-30. DOI:

Sanchez-Salcedo P, de-Torres JP, Martinez-Urbistondo D, Gonzalez-Gutierrez J, Berto J, Campo A et al. The neutrophil to lymphocyte and platelet to lymphocyte ratios as biomarkers for lung cancer development. Lung Cancer. 2016;97:28–34. DOI:

Van Egmond M, Bakema JE. Neutrophils as effector cells for antibody-based immunotherapy of cancer. Semin Cancer Biol. 2013;23:190–9. DOI:

Pan YC, Jia ZF, Cao DH, Wu YH, Jiang J, Wen SM et al. Preoperative lymphocyte-to-monocyte ratio (LMR) could independently predict overall survival of resectable gastric cancer patients. Medicine. 2018;97:e13896. DOI:

Zheng SH, Huang JL, Chen M, Wang BL, Ou QS, Huang SY. Diagnosis value of preoperative inflammatory markers in patients with glioma: a multicenter cohort study. J Neurosurg 2017;3:1-10. DOI: 10.3171/2017.3.JNS161648 DOI:

Baran O, Kemerdere R, Korkmaz TS, Kayhan A, Tanrıverdi T. Can preoperative neutrophil to lymphocyte, lymphocyte to monocyte or platelet ratios differentiate glioblastoma from brain metastasis?. Medicine 2019;98:50(e18306) DOI:

Kemal Y, Yücel I, Ekiz K, Demirag G, Yilmaz B, Teker F et al. Elevated Serum Neutrophil to Lymphocyte and Platelet to Lymphocyte Ratios Could be Useful in Lung Cancer Diagnosis. Asian Pac J Cancer Prev. 2015;15(6):2651-4. DOI:

Wu Y, Qin Y, Qin J, Zhang X, Lin F. Diagnostic value of derived neutrophil-to-lymphocyte ratio in patients with ovarian cancer. J Clin Lab Anal 2019;33;e22833. DOI:

Hanna RN, Cekic C, Sag D, Tacke R, Thomas GD, Nowyhed H et al. Patrolling Monocytes Control Tumor Metastasis to the Lung. Science. 2015;11(20):350;985-990. DOI: 10.1126/science.aac9407 DOI:

Hu P, Shen H, Wang G, Zhang P, Liu Q, Du J. Prognostic significance of systemic inflammation-based lymphocyte-monocyte ratio in patients with lung cancer: based on a large cohort study. PloS One.2014;9(9):e108062. DOI:

Yilmaz F, Tastekin G. Sensitivity of (18)F-FDG PET in evaluation of solitary pulmonary nodules. Int J Clin Exp Med. 2015; 8(1):45-51.