Evaluation of Systemic Inflammatory Markers in Predicting Malignancy in Parotid Gland Tumors

ABSTRACT

Objectives

To evaluate the diagnostic value of preoperative hematologic inflammatory indices in distinguishing benign from malignant parotid gland tumors and to assess their potential as adjunctive diagnostic tools.

Methods

This retrospective observational study included 259 patients who underwent parotidectomy at the Department of Otorhinolaryngology, Necmettin Erbakan University Faculty of Medicine, from January 2020 to January 2025. Demographic data, histopathologic diagnoses, and preoperative parameters were reviewed. Inflammatory indices (NLR, PLR, SII, SIRI, WMR, and NP/LHb) were calculated. Comparative analyses among pleomorphic adenoma, Warthin's tumor, and malignant tumors were performed using one‐way ANOVA, Kruskal–Wallis, and post hoc tests. Receiver operating characteristic (ROC) analysis was used to determine discriminative performance.

Results

Of the 259 patients, 101 had pleomorphic adenoma, 107 had Warthin tumor, and 51 had malignant tumors. Warthin tumors demonstrated significantly higher white blood cell, neutrophil, lymphocyte, monocyte, and hemoglobin levels than both pleomorphic adenoma and malignant tumors (p < 0.001). Malignant tumors were associated with older age, larger tumor size and volume, higher NLR and PLR values, and lower lymphocyte, monocyte, and hemoglobin levels (all p < 0.05). ROC analysis identified age (cut‐off: 60.5 years; AUC = 0.642) and tumor volume (cut‐off: 24.75 cm³; AUC = 0.664) as the strongest predictors of malignancy. An NLR cut‐off value of 1.62 yielded 86% sensitivity and 31% specificity for differentiating malignant from benign lesions.

Conclusions

Preoperative hematologic indices—NLR and PLR—may serve as inexpensive, accessible adjunctive tools in evaluating parotid masses. Integration of inflammatory indices into radiomics‐based or nomogram‐driven diagnostic models has the potential to improve diagnostic accuracy.

Level of Evidence

N/A

Preoperative systemic inflammatory indices may assist in distinguishing benign from malignant parotid tumors. In this cohort of 259 patients undergoing parotidectomy, malignant tumors were associated with higher neutrophil‐to‐lymphocyte ratio (NLR) and platelet‐to‐lymphocyte ratio (PLR) values, as well as larger tumor size and older age. These inexpensive laboratory markers may provide adjunctive information for preoperative risk stratification.

1. Introduction

The majority of parotid gland masses are benign. Approximately 70% of these lesions are pleomorphic adenomas, whereas 20%–25% are Warthin tumors [1]. Malignant salivary gland tumors most frequently arise in the parotid gland, and parotid malignancies account for nearly 3% of all head and neck cancers [2]. Among malignant parotid tumors, mucoepidermoid carcinoma and adenoid cystic carcinoma are the most common histopathological subtypes.

Most parotid gland tumors require surgical management. Preoperative imaging modalities—particularly magnetic resonance imaging (MRI)—together with fine‐needle aspiration biopsy (FNAB) play a pivotal role in preoperative evaluation and surgical planning [3, 4, 5]. The choice of surgical approach, ranging from superficial or total parotidectomy to extracapsular dissection, largely depends on the presumed preoperative diagnosis [6, 7]. However, FNAB findings do not always correlate accurately with final histopathological results. As a result, a falsely benign preoperative diagnosis may lead to inadequate surgical excision, whereas a false‐positive diagnosis of malignancy may result in unnecessarily extensive surgery, thereby increasing the risk of complications, particularly facial nerve injury. Despite substantial advances in imaging techniques and cytopathology, accurate preoperative differentiation between benign and malignant parotid lesions remains challenging.

Improving the accuracy of preoperative diagnosis is therefore crucial for optimal surgical decision‐making in parotid gland tumors. Although current diagnostic algorithms primarily rely on MRI characteristics and FNAB cytology, laboratory‐based predictive biomarkers have not yet been incorporated into routine clinical practice. In recent years, systemic inflammatory indices, including the neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR), and systemic immune‐inflammation index (SII), have been increasingly associated with tumor biology, tumor aggressiveness, and malignancy prediction across various cancer types.

In this study, we aimed to investigate the diagnostic utility of routinely available preoperative systemic inflammatory indices in differentiating benign from malignant parotid gland tumors using receiver operating characteristic (ROC) analysis. Unlike previous studies that primarily compared benign and malignant lesions as binary categories, our study simultaneously evaluated the three most prevalent histopathological entities—pleomorphic adenoma, Warthin tumor, and malignant tumors—and analyzed six distinct inflammatory indices, providing a more comprehensive assessment of their potential diagnostic value.

2. Materials and Methods

This study was approved by the Clinical Research Ethics Committee of Necmettin Erbakan University Faculty of Medicine (Approval no: 2025/6124; November 14, 2025). Given the retrospective design of the study based on anonymized patient records, informed consent was not required in accordance with institutional policy.

This retrospective cross‐sectional study included patients who underwent superficial or total parotidectomy at the Department of Otorhinolaryngology of Necmettin Erbakan University Faculty of Medicine between January 2020 and January 2025. Patients with malignancies other than salivary gland tumors, as well as those with chronic inflammatory or autoimmune diseases (including rheumatologic disorders or inflammatory bowel disease), were excluded. Consecutive patients undergoing parotidectomy during the study period were included to minimize selection bias.

Demographic characteristics, histopathological diagnoses, and preoperative laboratory data were retrieved retrospectively from the institutional electronic medical record system.

2.1. Calculation of Systemic Inflammatory Indices

Complete blood count (CBC) parameters obtained within 2 weeks before surgery were recorded. These parameters included white blood cell count (WBC), neutrophil count, lymphocyte count, monocyte count, platelet count, mean platelet volume (MPV), and hemoglobin level. Based on these values, the following systemic inflammatory indices were calculated:

• NLR (neutrophil/lymphocyte)

• PLR (platelet/lymphocyte)

• SII (neutrophil × platelet/lymphocyte)

• Systemic inflammatory response index (SIRI; neutrophil × monocyte/lymphocyte)

• White blood cell‐to‐MPV ratio (WMR; WBC/MPV)

• Neutrophil × platelet/lymphocyte × hemoglobin ratio (NP/LHb)

Histopathological diagnoses were categorized as pleomorphic adenoma, Warthin tumor, or malignant tumor. The malignant tumor group included all histopathologically confirmed salivary gland malignancies, regardless of subtype.

2.2. Statistical Analysis

Statistical analyses were performed using IBM SPSS Statistics software (IBM Corp., Armonk, NY, USA). Data distribution normality was assessed before statistical testing. Continuous variables with normal distribution were analyzed using one‐way analysis of variance (ANOVA), whereas non‐normally distributed variables were compared using the Kruskal–Wallis test. Categorical variables were analyzed using the chi‐square test.

For diagnostic performance analysis, patients were additionally classified into benign tumors (pleomorphic adenoma and Warthin tumor) and malignant tumors. ROC curve analysis was performed to assess the discriminative ability and optimal cut‐off values of systemic inflammatory indices for differentiating benign from malignant parotid gland tumors. The cut‐off value was determined based on the highest Youden index, and a p < 0.05 was considered statistically significant.

3. Results

A total of 259 patients were included in the study, comprising 101 (39.0%) patients with pleomorphic adenoma, 107 (41.3%) with Warthin tumor, and 51 (19.7%) with malignant tumors. The study population consisted of 165 males (63.7%) and 94 females (36.3%). A statistically significant difference in sex distribution was observed, with a marked male predominance in the Warthin tumor group (p < 0.001).

3.1. Comparison of Clinical and Laboratory Parameters Among Tumor Groups

The comparative analysis of demographic, hematological, and tumor‐related parameters among the three tumor groups is presented in Table 1. Significant intergroup differences were observed for age, WBC, neutrophil count, lymphocyte count, monocyte count, hemoglobin level, and WMR values (all p < 0.05).

TABLE 1.

Comparison of demographic, hematological, and tumor parameters among pleomorphic adenoma, Warthin tumor, and Malignant tumor groups.

Parameter	Pleomorphic adenoma (n = 101)	Warthin tumor (n = 107)	Malignant tumor (n = 51)	p
Age (years, mean ± SD)	45.5 ± 16.7	61.5 ± 10.5	61.1 ± 15.5	< 0.001 a
Gender (M/F)	45/56	92/15	28/23	< 0.001 a
WBC (×109/L)	7.6 ± 1.6	9.0 ± 1.8	7.7 ± 1.9	< 0.001 a
Neutrophil (×109/L)	4.6 ± 1.4	5.4 ± 1.5	4.9 ± 1.4	< 0.001 a
Lymphocyte (×109/L)	2.2 ± 0.56	2.6 ± 0.78	2.0 ± 0.77	< 0.001 a
Monocyte (×109/L)	0.53 ± 0.15	0.66 ± 0.16	0.55 ± 0.18	< 0.001 a
Hemoglobin (g/dL)	14.2 ± 1.8	15.3 ± 1.4	14.0 ± 1.7	< 0.001 a
MPV (fL)	10.3 ± 0.93	10.0 ± 0.89	10.1 ± 1.09	0.056 b
NLR	2.25 ± 1.21	2.29 ± 1.06	2.69 ± 1.23	0.054 b
PLR	131.5 ± 47.7	109.6 ± 40.3	153.6 ± 82.9	< 0.001 b
SIRI	1.22 ± 0.67	1.54 ± 0.81	1.50 ± 0.85	0.006 b
WMR	0.74 ± 0.18	0.90 ± 0.20	0.77 ± 0.21	< 0.001 a
NP/LHb	45.4 ± 28.5	40.4 ± 22.9	54.9 ± 37.8	0.057 b
Tumor size 1 (cm)	2.99 ± 1.23	3.39 ± 1.15	4.18 ± 2.21	< 0.001 b
Tumor size 2 (cm)	2.34 ± 0.94	2.54 ± 0.91	3.15 ± 1.82	0.003 b
Tumor volume (cm3)	18.5 ± 40.8	20.3 ± 21.0	44.7 ± 72.8	< 0.001 b

Abbreviations: MPV, mean platelet volume; SD, standard deviation.

^a The one‐way ANOVA test was used for normally distributed variables.

^b The Kruskal–Wallis test was used for non‐normally distributed variables.

Post hoc Tukey HSD analyses demonstrated that patients with Warthin tumor had significantly higher mean values of WBC, neutrophil, lymphocyte, monocyte, hemoglobin, and WMR compared with both the pleomorphic adenoma and malignant tumor groups. No statistically significant differences were detected between the pleomorphic adenoma and malignant tumor groups for these parameters.

According to Levene's test, the assumption of variance homogeneity was not met for sex, age, and hemoglobin levels; therefore, the Games–Howell post hoc test was applied. The Warthin tumor group exhibited significantly higher mean age and hemoglobin levels, as well as a significantly higher proportion of male patients, compared with the other groups (all p < 0.001).

Variables that violated normality assumptions—including NLR, PLR, SIRI, NP/LHb, and tumor size parameters—were further analyzed using the Kruskal–Wallis test followed by Tamhane post hoc comparisons (Table 2). The malignant tumor group demonstrated significantly larger tumor dimensions, higher NLR and PLR values, and lower lymphocyte count, monocyte count, and hemoglobin levels compared with the benign tumor groups (all p < 0.05).

TABLE 2.

Significant post hoc intergroup differences among tumor types (Games–Howell, Tukey HSD, and Tamhane tests).

Parameter	Test	Comparison (I–J)	Mean difference	p	Interpretation
Gender	Games–Howell	Pleomorphic adenoma < Warthin tumor	—	< 0.001	Higher male ratio in Warthin tumor
Age	Games–Howell	Warthin > pleomorphic/malignant > pleomorphic	+15.9/+15.6	< 0.001	Older age in the Warthin and malignant groups
Hb	Games–Howell	Warthin > pleomorphic/Warthin > malignant	+1.04/+1.29	< 0.001	Higher Hb in Warthin
WBC, neutrophil, lymphocyte, monocyte, WMR	Tukey HSD	Warthin > pleomorphic and malignant	—	< 0.001	Elevated in Warthin
PLR	Tamhane	Pleomorphic > Warthin/malignant > Warthin	+21.9/+44.0	< 0.01	PLR high in pleomorphic and malignant
SIRI	Tamhane	Warthin > pleomorphic	+0.32	0.008	Higher SIRI in Warthin
NP/LHb	Tamhane	Malignant > Warthin	+14.5	0.042	Higher NP/LHb in malignant
Tumor size	Tamhane	Malignant > pleomorphic/Warthin > pleomorphic	—	< 0.05	Largest in malignant group

Note: Only p < 0.05 differences are shown.

When pleomorphic adenoma and Warthin tumor cases were combined into a benign tumor group and compared with malignant tumors, significant differences were observed in age, tumor size, tumor volume, lymphocyte count, monocyte count, hemoglobin level, NLR, and PLR values (all p < 0.05). The results of the Mann–Whitney U test and corresponding ROC analyses are summarized in Table 3.

TABLE 3.

Comparison between benign and malignant groups (Mann–Whitney U test).

Variable	Z	p	Interpretation
Age	−3.160	0.002	Higher in malignant group
Tumor size 1–3/volume	−3.244 to −3.653	0.001–0.037	Larger in malignant group
Lymphocyte	−3.389	0.001	Lower in malignant group
Monocyte	−2.507	0.012	Lower in malignant group
Hemoglobin	−2.678	0.007	Lower in malignant group
NLR	−2.219	0.027	Higher in malignant group
PLR	−2.261	0.024	Higher in malignant group

3.2. ROC Analysis

ROC analysis revealed that the discriminatory performance of individual variables in differentiating benign from malignant parotid gland tumors ranged from poor to moderate (Table 4). Among all evaluated parameters, tumor volume demonstrated the highest diagnostic accuracy (AUC = 0.664, p < 0.001), followed by age (AUC = 0.642; p = 0.002) and tumor size measurements (AUC = 0.636–0.645; p < 0.01).

TABLE 4.

ROC analysis for parameters differentiating benign and malignant parotid tumors.

Variable	AUC	95% CI	p	Cut‐off	Sensitivity (%)	Specificity (%)	Youden index
Age	0.642	0.55–0.72	0.002	60.5 years	65	62	0.277
Tumor size 1	0.645	0.55–0.73	0.001	4.25 cm	46	87	0.302
Tumor size 2	0.636	0.54–0.72	0.002	2.95 cm	61	72	0.335
Tumor volume	0.664	0.57–0.75	< 0.001	24.75 cm3	57	78	0.364
NLR	0.600	0.52–0.68	0.027	1.62	86	31	0.179
PLR	0.601	0.52–0.69	0.024	130.8	51	69	0.215

The optimal cut‐off value for age was determined as 60.5 years, yielding a sensitivity of 65%, specificity of 62%, and a Youden index of 0.277. For tumor size and tumor volume, cut‐off values of 4.25 cm, 2.95 cm, and 24.75 cm³ were identified, with sensitivities ranging from 46% to 61% and specificities between 72% and 87%.

Both NLR (AUC = 0.600) and PLR (AUC = 0.601) demonstrated limited discriminatory ability, with optimal cut‐off values of 1.62 and 130.8, respectively. Although the overall diagnostic accuracy of NLR and PLR was modest, their high sensitivity suggests potential utility as adjunctive parameters for excluding malignancy, particularly in the preoperative evaluation of parotid masses.

In summary, malignant parotid gland tumors were associated with advanced age, larger tumor size and volume, elevated NLR and PLR values, and reduced lymphocyte count, monocyte count, and hemoglobin levels compared with benign lesions. Among all evaluated parameters, age exhibited the strongest individual predictive value for malignancy, as demonstrated by ROC analysis (Figure 1).

FIGURE 1.

Receiver operating characteristic (ROC) curves of systemic inflammatory indices for distinguishing malignant from benign parotid tumors. [Color figure can be viewed in the online issue, which is available at www.laryngoscope.com]

4. Discussion

Surgical excision remains the cornerstone of treatment for parotid gland tumors, and both the extent of surgery and postoperative surveillance strategies are determined primarily by the histopathological nature of the lesion. Partial superficial parotidectomy is generally recommended for pleomorphic adenoma to minimize recurrence risk, whereas enucleation may be an appropriate option for selected cases of Warthin tumor, and radical resections with clear surgical margins are required in malignant disease [7]. Given that histopathological diagnosis directly influences the surgical approach, preoperative fine‐needle aspiration cytology (FNAC) is routinely employed in clinical practice [3, 8].

Although FNAC demonstrates reasonable overall diagnostic accuracy, its sensitivity and specificity vary across histological subtypes, and cytologically indeterminate findings remain a significant clinical challenge. As a result, FNAC alone may be insufficient to reliably guide surgical decision‐making in all cases, highlighting the need for adjunctive laboratory and imaging‐based markers to improve preoperative risk stratification. In this context, systemic inflammatory indices may provide additional diagnostic value, particularly in patients with indeterminate cytology, where reliance on FNAC alone carries a risk of undertreatment or overtreatment [8, 9].

Recent evidence further supports this complementary diagnostic strategy, demonstrating that integrating systemic inflammatory biomarkers with advanced imaging approaches, such as radiomics‐derived features, can enhance the preoperative differentiation of salivary gland tumors, especially when conventional cytological assessment yields inconclusive results [10]. Such multimodal approaches may help optimize surgical planning and reduce procedure‐related morbidity by improving diagnostic confidence before intervention.

To our knowledge, this is one of the few studies to simultaneously compare multiple systemic inflammatory indices across pleomorphic adenoma, Warthin tumor, and malignant parotid tumors within a single cohort, highlighting distinct inflammatory profiles among both benign and malignant subtypes.

The elevated systemic inflammatory markers detected in malignant parotid tumors can be explained by a biologically plausible and well‐established mechanism. It has been demonstrated that malignant neoplasms stimulate increased neutrophil production, a process driven by the excessive release of pro‐inflammatory cytokines within the tumor microenvironment. Key mediators of this response include interleukin‐6, tumor necrosis factor‐α, and granulocyte colony‐stimulating factor (G‐CSF) [11]. Conversely, reduced lymphocyte counts reflect an impaired antitumor immune response, particularly through the suppression of cytotoxic T lymphocytes and natural killer (NK) cell activity.

As a result, composite indices such as the NLR, PLR, and SII represent more than simple markers of peripheral inflammation and reflect the biological imbalance between tumor‐promoting inflammatory activity and host immune surveillance. Consistent evidence from the literature indicates that elevated NLR and related inflammatory indices across multiple solid malignancies are associated with poorer prognosis, increased tumor aggressiveness, and more advanced disease stage [12, 13]. The significantly higher inflammatory marker levels observed in the malignant group in the present study align closely with this established mechanistic framework.

Beyond their diagnostic discriminatory value, parotid‐specific investigations have further demonstrated the prognostic relevance of these indices, particularly NLR. Seng et al. and Gao et al. reported that elevated pretreatment NLR values were associated with inferior oncologic outcomes in pediatric parotid malignancies, including mucoepidermoid carcinoma [14, 15]. Similarly, Cheng et al. identified high NLR as an independent predictor of reduced survival in patients with primary parotid gland carcinoma [16]. More recently, a systematic review by Zaidi et al. confirmed the prognostic significance of NLR across a broad spectrum of salivary gland neoplasms, reinforcing its clinical relevance as a biologically meaningful biomarker rather than a nonspecific indicator of systemic inflammation [17].

In the present study, we systematically compared multiple preoperative inflammatory indices across three major histopathological subtypes of parotid gland tumors: pleomorphic adenoma, Warthin tumor, and malignant lesions. Our analysis revealed that patients with Warthin tumor exhibited significantly higher total WBCs, as well as elevated neutrophil, lymphocyte, and monocyte levels, in addition to higher hemoglobin values, compared with both pleomorphic adenoma and malignant tumor groups. This hematologic profile is noteworthy, as it suggests a distinct inflammatory and immunologic milieu associated with Warthin tumor.

Although numerous studies have explored the utility of simple blood‐based inflammatory markers in differentiating benign from malignant salivary gland tumors, data directly comparing pleomorphic adenoma and Warthin tumor remain scarce [18, 19, 20, 21]. In this context, our findings contribute novel comparative evidence, indicating that routinely available preoperative hematologic parameters—particularly those elevated in Warthin tumors—may serve as useful adjuncts to radiologic and cytological evaluation, given their low cost, accessibility, and reproducibility.

Our results are consistent with previous studies assessing the diagnostic performance of NLR and PLR in benign versus malignant parotid lesions. Aslan and Tan reported that NLR and PLR could aid in preoperative discrimination between benign and malignant parotid masses, although diagnostic accuracy varied, highlighting the limitations of these indices as standalone tools [22]. Similarly, Ye et al. demonstrated that peripheral blood inflammatory markers contribute to the differentiation of benign and malignant parotid gland tumors, while emphasizing that optimal diagnostic performance is achieved when these parameters are interpreted within an integrated clinical, radiological, and cytological framework [23].

Recent literature has increasingly focused on systemic inflammatory indices—including NLR, PLR, SII, and SIRI—as potential diagnostic and prognostic biomarkers in head and neck and salivary gland neoplasms [24, 25, 26, 27, 28]. While these indices have been associated with tumor progression and adverse pathological features, reported cut‐off values and diagnostic performance remain heterogeneous across different cohorts and study designs.

In our cohort, NLR did not differ significantly among the three histopathological subgroups when analyzed individually. PLR was significantly higher in pleomorphic adenoma compared with Warthin tumor, and was also elevated in malignant tumors relative to Warthin tumor. SIRI values were higher in Warthin tumors compared with pleomorphic adenoma, whereas the NP/LHb was significantly elevated in malignant tumors compared with Warthin tumors. These findings suggest that different inflammatory indices may capture distinct aspects of tumor‐related immune and hematologic alterations rather than reflecting a uniform inflammatory response.

When tumors were dichotomized into benign and malignant categories, NLR and PLR values were significantly higher in the malignant group, whereas SII, SIRI, NP/LHb, and WMR did not demonstrate statistically significant differences. ROC analysis identified an NLR cut‐off value of 1.62 (sensitivity 86%, specificity 31%) and a PLR cut‐off value of 130.8 (sensitivity 51%, specificity 69%). Although specificity was limited, particularly for NLR, these parameters may still offer clinically meaningful adjunctive information, especially in settings where access to advanced imaging or rapid core needle biopsy is limited.

Systemic inflammatory markers should not be interpreted in isolation, as patient comorbidities, active infections, hematologic disorders, smoking status, and concomitant medications can substantially influence peripheral blood counts. These potential confounders must be carefully considered, and prospective validation with clearly defined exclusion criteria is necessary before routine clinical implementation.

Furthermore, recent studies integrating systemic inflammatory markers with diffusion‐weighted MRI (DWI‐MRI) parameters have demonstrated improved diagnostic accuracy in distinguishing benign from malignant parotid tumors, underscoring that inflammatory indices yield their highest diagnostic value when interpreted within integrated, multimodal diagnostic frameworks rather than as isolated parameters [29, 30].

In our series, tumor size and volume were significantly greater in malignant cases, and both Warthin tumor and malignant tumors demonstrated larger dimensions compared with pleomorphic adenoma. These findings are consistent with previous reports suggesting that parotid lesions exceeding 3 cm in diameter warrant heightened suspicion for malignancy [5, 31, 32]. ROC analysis identified an age threshold of > 60.5 years for malignancy prediction, with moderate sensitivity and specificity, aligning with epidemiologic data demonstrating increasing malignancy rates with advancing age. The male predominance observed in the Warthin tumor group further corroborates established epidemiologic patterns, likely reflecting the strong association between Warthin tumor and smoking [5].

The principal strengths of this study include the focused comparison of the three most frequently encountered parotid tumor histologies and the simultaneous evaluation of multiple systemic inflammatory indices within a single cohort. Nevertheless, several limitations merit acknowledgment. The retrospective design introduces potential selection bias and limits control over confounding variables. The absence of long‐term follow‐up data precluded assessment of recurrence and survival outcomes, and the single‐center nature of the cohort limits generalizability. Finally, the modest diagnostic performance of individual inflammatory indices underscores that these markers should be incorporated into multivariable diagnostic models rather than used as standalone tools.

Future research should focus on prospective, multicenter studies evaluating integrated diagnostic models that combine clinical variables (such as age, sex, and tumor size), imaging‐based radiomics, cytologic assessment using standardized systems (e.g., the Milan system), and systemic inflammatory biomarkers [19, 20]. Such integrated approaches are likely to provide greater diagnostic accuracy and clinical utility than any single modality alone.

5. Conclusion

In conclusion, although MRI and FNAC remain the cornerstone modalities in the preoperative evaluation of parotid gland masses, readily available systemic hematological inflammatory indices may offer complementary diagnostic value, particularly in cases with inconclusive cytologic findings. In daily otolaryngology practice, these indices may be especially useful when FNAC results are indeterminate or discordant with imaging findings.

Integration of inflammatory indices into radiomics‐based or nomogram‐driven diagnostic models has the potential to improve diagnostic accuracy and inform surgical decision‐making, particularly in resource‐limited settings. From a clinical perspective, parotid lesions exceeding 3 cm in diameter or occurring in patients older than 60.5 years should be approached with heightened suspicion for malignancy. In our cohort, an NLR value greater than 1.62 demonstrated high sensitivity but limited specificity, supporting its role as a cost‐effective adjunctive marker rather than a substitute for established diagnostic pathways. Prospective, multicenter studies are warranted to validate these findings and to define the role of systemic inflammatory indices within integrated, multivariable diagnostic algorithms.

Funding

The authors have nothing to report.

Ethics Statement

This retrospective study was approved by the Necmettin Erbakan University Faculty of Medicine Ethics Committee (approval no: 2025/6124, November14, 2025). As this was a retrospective chart review, informed consent was not required in accordance with institutional policy.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.