The additional diagnostic value of NLR and PLR for CA-125 in the differential diagnosis of endometrioma and benign ovarian cysts in women of reproductive age: a retrospective case-control study

Ziya Kalem, Çoşkun ŞİMŞİR, Batuhan Bakırarar, Müberra Namlι Kalem
In: The European Research Journal · 2019 · vol. 6(2) , pp. 111–119 · doi:10.18621/eurj.483442 · W2915382032
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Neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) did not improve the diagnostic value of CA-125 for differentiating endometrioma from benign ovarian cysts.

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⚙ AI-generated deep summary by claude@2026-07, 2026-07-09 · read from full text ⓘ

This retrospective case-control study analyzed 213 women under 40 years who underwent laparoscopic or laparotomic surgery for ovarian cysts from 2015 to 2018, comparing histopathologically confirmed endometriomas with other benign ovarian cysts. Preoperative data included CA-125, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), complete blood counts, age, BMI, ultrasound findings, FSH levels, and symptoms such as dysmenorrhea, dyspareunia, and chronic pelvic pain. Although NLR, PLR, and CA-125 were higher in endometrioma cases, adding NLR and/or PLR did not improve the sensitivity or specificity of CA-125 for differentiating endometrioma from benign cysts. The paper finds no association between CA-125 and clinical symptoms, while NLR related to dysmenorrhea and PLR to lesion size, and it does not explicitly state other limitations beyond the retrospective design. This paper is centrally about endometriosis — it evaluates whether NLR and PLR add diagnostic value to CA-125 for distinguishing endometriomas from other benign ovarian cysts.

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Abstract

Objectives: Aim of this study is to investigate the diagnostic value of neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) for cancer antigen-125 (CA-125) in a differential diagnosis of endometrioma from benign ovarian cysts.Methods: In this retrospective study, the medical data of a total of 213 patients aged < 40 years who underwent laparoscopic or laparotomic surgery for ovarian cysts between April 2015 and June 2018 were analyzed. The patients were divided into two groups, as those with endometriomas and those with other benign ovarian cysts, all which had been confirmed histopathologically. Data on age, body mass index (BMI), preoperative US findings, complete blood count analysis results, follicle-stimulating hormone (FSH) levels, and the presence of dysmenorrhea, dyspareunia and chronic pelvic pain were recorded.Results: NLR, PLR and CA-125 were increased in the patients with endometrioma, although increases in the NLR and PLR alone or combined did not contribute to the sensitivity or specificity of CA-125. Conclusions: The results of our study suggest that NLR and PLR did not contribute to the diagnostic value of CA-125 in the preoperative differential diagnosis of endometriomas or other benign ovarian cysts. In addition, CA-125 was not associated with clinical symptoms, although a relationship was identified between NLR and dysmenorrhea, and between PLR and lesion size, which may be the research focus of further studies.
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Methods

In this retrospective study, the medical data of a total of 213 patients aged < 40 years who underwent laparoscopic or laparotomic surgery for ovarian cysts between April 2015 and June 2018 were analyzed. The patients were divided into two groups, as those with endometriomas and those with other benign ovarian cysts, all which had been confirmed histopathologically. Data on age, body mass index (BMI), preoperative US findings, complete blood count analysis results, follicle-stimulating hormone (FSH) levels, and the presence of dysmenorrhea, dyspareunia and chronic pelvic pain were recorded.

Results

NLR, PLR and CA-125 were increased in the patients with endometrioma, although increases in the NLR and PLR alone or combined did not contribute to the sensitivity or specificity of CA-125.

Conclusions

The results of our study suggest that NLR and PLR did not contribute to the diagnostic value of CA-125 in the preoperative differential diagnosis of endometriomas or other benign ovarian cysts. In addition, CA-125 was not associated with clinical symptoms, although a relationship was identified between NLR and dysmenorrhea, and between PLR and lesion size, which may be the research focus of further studies. 1. Strauss JF, Barbieri RL. Yen & Jaffe's Reproductive Endocrinology E-Book: Physiology, Pathophysiology, and Clinical Management. Elsevier Health Sciences. 2013. 2. Raffi F, Metwally M, Amer S. The impact of excision of ovarian endometrioma on ovarian reserve: a systematic review and meta-analysis. J Clin Endocrinol Metab 2012;97:3146-54. 3. Tanbo T, Fedorcsak P. Endometriosis‐associated infertility: aspects of pathophysiological mechanisms and treatment options. Acta Obstet Gynecol Scand 2017;96:659-67. 4. Clement PB. 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Kajihara H, Yamada Y, Kanayama S, Furukawa N, Noguchi T, Haruta S, et al. New insights into the pathophysiology of endometriosis: from chronic inflammation to danger signal. Gynecol Endocrinol 2011;27:73-9. 15. Cho S, Cho H, Nam A, Kim HY, Choi YS, Park KH, et al. Neutrophil-to-lymphocyte ratio as an adjunct to CA-125 for the diagnosis of endometriosis. Fertil Steril 2008;90:2073-9. 16. Sayan CD, Özakşit MG, Sarikaya E, Eryılmaz ÖG, Mollamahmutoğlu L, Deveer R. Serum interleukin-8, CA-125 levels, neutrophil-to-lymphocyte ratios, and combined markers in the diagnosis of endometriosis. Turk J Med Sci 2013;43:417-23. 17. Yang H, Lang JH, Zhu L, Wang S, Sha GH, Zhang Y. Diagnostic value of the neutrophil-to-lymphocyte ratio and the combination of serum CA-125 for stages III and IV endometriosis. Chin Med J 2013;126:2011-14. 18. Kim SK, Park JY, Jee BC, Suh CS, Kim SH. Association of the neutrophil-to-lymphocyte ratio and CA-125 with the endometriosis score. Clin Exp Reprod Med 2014;41:151-7. 19. Yavuzcan A, Çağlar M, Üstün Y, Dilbaz S, Özdemir İ, Yıldız E, et al. Evaluation of mean platelet volume, neutrophil/lymphocyte ratio and platelet/lymphocyte ratio in advanced stage endometriosis with endometrioma. J Turk Ger Gynecol Assoc 2013;14:210-5. 20. Surya IU, Harzif AK, Maidarti M, Pratama G, Wiweko B. Expression of CA-125 level and neutrophil to lymphocyte ratio in infected and non-infected endometrioma. KnE Medicine 2017;1:173-9. 21. Yildirim MA, Seckin KD, Togrul C, Baser E, Karsli MF, Gungor T, et al. Roles of neutrophil/lymphocyte and platelet/lymphocyte ratios in the early diagnosis of malignant ovarian masses. Asian Pac J Cancer Prev 2014;15:6881-5. 22. Topcu HO, Guzel AI, Ozer I, Kokanali MK, Gokturk U, Muftuoglu KH, et al. Comparison of neutrophil/lymphocyte and platelet/lymphocyte ratios for predicting malignant potential of suspicious ovarian masses in gynecology practice. Asian Pac J Cancer Prev 2014;15:6239-41. 23. Osuga Y, Koga K, Hirota Y, Hirata T, Yoshino O, Taketani Y. Lymphocytes in endometriosis. Am J Reprod Immunol 2011;65:1-10. 24. Yang H, Zhu L, Wang S, Lang J, Xu T. Noninvasive diagnosis of moderate to severe endometriosis: the platelet-lymphocyte ratio cannot be a neoadjuvant biomarker for serum cancer antigen 125. J Minim Invasive Gynecol 2015;22:373-7. 25. Tokmak A, Yildirim G, Öztaş E, Akar S, Erkenekli K, Gülşen P, et al. Use of neutrophil-to-lymphocyte ratio combined with CA-125 to distinguish endometriomas from other benign ovarian cysts. Reprod Sci 2016;23:795-802. 26. Kucur SK, Seven A, Yuksel KB, Sencan H, Gozukara I, Keskin N. Mean platelet volume, a novel biomarker in adolescents with severe primary dysmenorrhea. J Pediatr Adolesc Gynecol 2016;29:390-2. 27. Maiorana A, Cicerone C, Niceta M, Alio L. Evaluation of serum CA 125 levels in patients with pelvic pain related to endometriosis. Int J Biol Markers 2007;22:200-2. 28. Jiang C, Liu C, Guo J, Chen L, Luo N, Qu X, et al. CA125 modified by PLT and NLR improves the predictive accuracy of adenomyosis-derived pelvic dense adhesion. Medicine (Baltimore) 2017;96:e6880. Copyright (c) 2020 The European Research Journal This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. Downloads Article Information - Article Type Research Article - Submitted February 21, 2026 - Published March 3, 2020 - Issue Vol. 6 No. 2 (2020) - Section Research Article

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