{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T18:17:03Z","timestamp":1785521823981,"version":"3.56.0"},"reference-count":12,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T00:00:00Z","timestamp":1777939200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T00:00:00Z","timestamp":1777939200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Inonu University"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Arch Otorhinolaryngol"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Accurate preoperative differentiation of cervical lymphadenopathy (LAP) is essential for optimal surgical planning. This study aimed to evaluate the contribution of preoperative pan-immune-inflammation value (PIV), platelet-to-lymphocyte ratio (PLR), demographic characteristics, and ultrasonographic findings in predicting malignant histopathology in patients undergoing excisional biopsy for cervical LAP, and to develop a practical clinical risk score.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>This retrospective cohort study was conducted at a tertiary referral center between January 2014 and December 2025. Patients who underwent excisional cervical lymph node biopsy with available preoperative ultrasonography and complete blood count data were included. The primary outcome was malignant versus non-malignant (reactive or granulomatous) histopathology. Candidate predictors included age, sex, neck level, ultrasonographic features (hilum loss, conglomeration, roundness index, and longest diameter), and inflammatory indices (PIV and PLR). Independent predictors were identified using multivariable logistic regression analysis, while discriminatory performance and optimal cut-off values were assessed using receiver operating characteristic (ROC) analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 481 patients included, 184 (38.2%) had reactive, 91 (18.9%) granulomatous, and 206 (42.8%) malignant histopathology. Patients with malignancy were older (median age, 51.5 years) and more frequently male (65.5%) (both\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Multivariable analysis demonstrated that conglomeration (OR, 6.18), male sex (OR, 3.51), Level V localization (OR, 7.77), increased roundness index (OR, 2.33), age (OR per year, 1.04), and PIV (OR per unit, 1.001) were independently associated with malignancy. Although PIV showed moderate discriminatory ability (AUC, 0.624), it achieved high specificity (83.3%) at a cut-off value\u2009&gt;\u2009567.1. A six-variable, points-based clinical scoring system (range, 0\u201311) effectively stratified malignancy risk (7.4% in the low-risk group and 83.1% in the high-risk group).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Malignancy risk in cervical lymphadenopathy can be reliably predicted through the combined assessment of demographic characteristics, ultrasonographic patterns, and the Pan-Immune-Inflammation Value. Conglomeration, Level V localization, advanced age, and elevated PIV emerged as the strongest independent predictors of malignancy. However, multicenter external validation is required before the proposed risk score can be implemented in routine clinical practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00405-026-10282-0","type":"journal-article","created":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T16:15:30Z","timestamp":1777997730000},"page":"5247-5254","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Predictive value of pan-immune-inflammation value and ultrasonographic parameters in cervical lymphadenopathy: development of a novel clinical scoring system"],"prefix":"10.1007","volume":"283","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0707-9984","authenticated-orcid":false,"given":"Mehmet","family":"Aslan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baransel","family":"Algan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,5]]},"reference":[{"issue":"1","key":"10282_CR1","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1007\/s12070-023-04213-2","volume":"76","author":"R Sharma","year":"2023","unstructured":"Sharma R, Kalsotra G, Mahajan D et al (2023) Prognostic Significance of Pre-Treatment Neutrophil\u2013Lymphocyte Ratio and Platelet-Lymphocyte Ratio in Head and Neck Malignancies. Indian J Otolaryngol Head Neck Surg 76(1):567\u2013574. https:\/\/doi.org\/10.1007\/s12070-023-04213-2","journal-title":"Indian J Otolaryngol Head Neck Surg"},{"key":"10282_CR2","doi-asserted-by":"publisher","first-page":"11752","DOI":"10.1186\/s12885-023-11752-y","volume":"23","author":"DT Bui","year":"2023","unstructured":"Bui DT, Rao SD, Surapaneni R et al (2023) Correlation between preoperative peripheral blood NLR, PLR, LMR and prognosis of patients with head and neck squamous cell carcinoma. BMC Cancer 23:11752. https:\/\/doi.org\/10.1186\/s12885-023-11752-y","journal-title":"BMC Cancer"},{"issue":"3","key":"10282_CR3","doi-asserted-by":"publisher","first-page":"e12219","DOI":"10.1111\/jicd.12219","volume":"8","author":"S Acharya","year":"2017","unstructured":"Acharya S, Rai P, Hallikeri K, Anehosur V, Kale J (2017) Preoperative platelet lymphocyte ratio is superior to neutrophil lymphocyte ratio to be used as predictive marker for lymph node metastasis in oral squamous cell carcinoma. J Investig Clin Dent 8(3):e12219. https:\/\/doi.org\/10.1111\/jicd.12219","journal-title":"J Investig Clin Dent"},{"key":"10282_CR4","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1186\/1477-7819-12-58","volume":"12","author":"JF Feng","year":"2014","unstructured":"Feng JF, Huang Y, Chen QX (2014) Preoperative platelet lymphocyte ratio (PLR) is superior to neutrophil lymphocyte ratio (NLR) as a predictive factor in patients with esophageal squamous cell carcinoma. World J Surg Onc 12:58. https:\/\/doi.org\/10.1186\/1477-7819-12-58","journal-title":"World J Surg Onc"},{"issue":"6","key":"10282_CR5","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1097\/00004424-200206000-00005","volume":"37","author":"A Ahuja","year":"2002","unstructured":"Ahuja A, Ying M (2002) An overview of neck node sonography. Invest Radiol 37(6):333\u2013342","journal-title":"Invest Radiol"},{"key":"10282_CR6","doi-asserted-by":"publisher","unstructured":"ChengH-W et al (2024) Prognostic role of the systemic immuneinflammation index and pan-immune inflammation value for outcomes of breast cancer: a systematic review and meta-analysis. Eur Rev Med Pharmacol Sci 28(1). https:\/\/doi.org\/10.26355\/eurrev_202401_34903","DOI":"10.26355\/eurrev_202401_34903"},{"issue":"1","key":"10282_CR7","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1007\/s12094-024-03558-6","volume":"27","author":"J Shi","year":"2025","unstructured":"Shi J et al (2025) Pan-immune-inflammation value: A new prognostic index in operative laryngeal and pharyngeal carcinomas. Clin Transl Oncol 27(1):151\u2013159","journal-title":"Clin Transl Oncol"},{"key":"10282_CR8","doi-asserted-by":"publisher","first-page":"107327482412907","DOI":"10.1177\/10732748241290746","volume":"31","author":"E Topkan","year":"2024","unstructured":"Topkan E et al (2024) Prognostic value of pre-chemoradiotherapy pan-immune-inflammation value (PIV) in locally advanced nasopharyngeal cancers. Cancer Control 31:10732748241290746","journal-title":"Cancer Control"},{"issue":"5","key":"10282_CR9","doi-asserted-by":"publisher","first-page":"2471","DOI":"10.1007\/s00405-022-07804-x","volume":"280","author":"D Guven","year":"2023","unstructured":"Guven D, Can et al (2023) The association between pan-immune-inflammation value and survival in head and neck squamous cell carcinoma. Eur Arch Otorhinolaryngol 280(5):2471\u20132478","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"10282_CR10","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1159\/000534079","volume":"861","author":"P Gaudioso","year":"2024","unstructured":"Gaudioso P, Piergiorgio, et al et al (2024) Blood markers predicting clinically occult lymph node metastasis in head and neck squamous cell carcinoma. Orl 861:32\u201340","journal-title":"Orl"},{"issue":"4","key":"10282_CR11","first-page":"354","volume":"8","author":"FB Metin","year":"2021","unstructured":"Metin FB, Ulas (2021) Erdem Mengi, and Cuneyt Orhan Kara. Risk analysis in persistent cervical lymphadenopathies: Malignant or benign? North Clin \u0130stanbul 8(4):354","journal-title":"North Clin \u0130stanbul"},{"issue":"1","key":"10282_CR12","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1007\/s00405-015-3717-3","volume":"273","author":"F Celenk","year":"2016","unstructured":"Celenk F et al (2016) Predictive factors for malignancy in patients with persistent cervical lymphadenopathy. Eur Arch Otorhinolaryngol 273(1):251\u2013256","journal-title":"Eur Arch Otorhinolaryngol"}],"container-title":["European Archives of Oto-Rhino-Laryngology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00405-026-10282-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00405-026-10282-0","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00405-026-10282-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T17:07:35Z","timestamp":1785517655000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00405-026-10282-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,5]]},"references-count":12,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10282"],"URL":"https:\/\/doi.org\/10.1007\/s00405-026-10282-0","relation":{},"ISSN":["0937-4477","1434-4726"],"issn-type":[{"value":"0937-4477","type":"print"},{"value":"1434-4726","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,5]]},"assertion":[{"value":"8 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors have no conflicts of interest to declare.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors have no conflicts of interest to declare.","order":2,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The article\u2019s ethical approval was obtained from the Ethics Committee of Inonu University, Malatya, Turkey (Approval No: 2025\/8738).","order":3,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}}]}}