Neutrophil-To-Lymphocyte and Platelet-To-Lymphocyte Ratios in atypical endometriosis and in Endometriosis-Associated ovarian-Cancer

INTRODUCTION: Atypical endometriosis (AE) is a histologically distinct entity considered a potential precursor to Endometriosis-Associated Ovarian Cancer (EAOC). Preoperative diagnosis is challenging as imaging often fails to distinguish AE from benign ovarian endometrioma (OMA). This study evaluated the diagnostic performance of inflammatory biomarkers, specifically Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR), in predicting AE. METHODS: We conducted a retrospective analysis of 105 patients surgically treated between 2015 and 2024. The cohort included women with histologically confirmed AE (n = 15), benign OMA (n = 45), and EAOC (n = 45). Preoperative blood samples were analyzed to calculate NLR and PLR. Statistical analysis included group comparisons, logistic regression to identify predictors of atypia, and Receiver Operating Characteristics (ROC) curve analysis to determine optimal cut-offs. RESULTS: Patients with EAOC exhibited significantly higher NLR (p = 0.002) and PLR (p = 0.001) compared to benign OMA. While mean biomarkers levels did not differ significantly between AE and benign OMA in univariate analysis, logistic regression identified cyst size (p = 0.017) and NLR (p = 0.025) as significant independent predictors of progression from typical to atypical OMA. The optimal NLR threshold for detecting AE was 2.294 (AUC 0.77), yielding a sensitivity of 70.0% and specificity of 75.6%. PLR distinguished malignancy but was not a significant predictor for AE. CONCLUSION: NLR is a promising, non-invasive biomarker for the early detection of atypical endometriosis. An NLR value > 2.294, particularly in larger cysts, may assist in preoperative risk stratification, identifying patients who require specialized surgical management to rule out malignant transformation.