Evaluation of Hematological Inflammatory Markers in Differentiating Benign from Malignant Endometrial Lesions in Women with Abnormal Uterine Bleeding

Section: Research Paper
Issue
Vol. 48 No. 1 (2026): Volume 48 Issue 1
Pages
100-105

Keywords:

Endometrial carcinoma, Endometrial thickness, Hematological inflammatory marker, Neutrophil lymphocyte ratio, Platelet-lymphocyte ratio

Abstract

Background:  Although endometrial sampling was used to confirm endometrial cancer in women with abnormal uterine bleeding (AUB) but it could be challenging due to anesthesia and surgical risks as well as due to patients’ refusal. Many biomarkers were start to be studied to predict endometrial carcinoma (EC) and to avoid unnecessary intervention.


Aim: This study emphasized on the role of some hematological inflammatory markers (HIM) in differentiation of benign from malignant endometrial pathologies alone and in addition to endometrial thickness (ET).


Patients and Methods: prospective multicenter case series study of 120 patients with AUB were admitted for surgical intervention in five governmental and private hospitals in Mosul city, Iraq. Blood tests were done preoperatively in addition to ultrasound examination for ET. After obtaining histopathological results, patients were divided into two groups; those with benign endometrial lesions (105 patients) and those with endometrial carcinoma (15 patients). The results of HIM and ET were analyzed statistically. Patients with EC were older with higher body mass index (BMI) than those with benign endometrial lesions. The platelet counts, mean platelet volume (MPV), neutrophil-lymphocyte ratio (NLR), platelet- lymphocyte ratio (PLR) and endometrial thickness (ET) were all significantly higher in case of malignancy than benign lesions, lymphocyte count was significantly lower in cases of malignancy. Adding ET to each marker increase its validity indicators mainly neutrophil, lymphocyte, NLR and PLR which increase its negative predictive value significantly. 


Conclusion: Combining HIM and ET measurement shows significant promise as a supportive, non-invasive way to held distinguish between benign and malignant lesions. However, larger studies are needed to fully confirm these findings before they can be used as a standard diagnostic indicator. 

References

  1. Petric AN, Živadinović R, Mitić D, Stanojević M., Živadinović A., Kostić I. Hematological and biochemical markers in determining the diagnosis and stage prediction of endometrial cancer. Ginekol Pol. 2023;94[4]:283–90. Doi: https://doi.org/10.5603/GP.a2022.0038
  2. Jain V, Munro MG, Critchley HOD. Contemporary evaluation of women and girls with abnormal uterine bleeding: FIGO Systems 1 and 2. International Journal of Gynecology and Obstetrics. 2023 Aug 1;162[S2]:29–42. Doi: https://doi.org/10.1002/ijgo.14946.
  3. Hapangama DK, Bulmer JN. Pathophysiology of heavy menstrual bleeding. Women’s Health. 2016 Jan 1;12[1]:3–13. Doi: https://doi.org/10.2217/whe.15.81
  4. Hutt S, Tailor A, Ellis P, Michael A, Butler-Manuel S, Chatterjee J. The role of biomarkers in endometrial cancer and hyperplasia: a literature review. Acta Oncologica. Taylor and Francis Ltd; 2019. p. 342–52. Doi: https://doi.org/10.1080/0284186X.2018.1540886
  5. Braun MM, Overbeek-Wager EA, Grumbo RJ. Diagnosis and management of endometrial cancer. American family physician. 2016 Mar 15;93(6):468-74.
  6. Jones ER, O’Flynn H, Njoku K, Crosbie EJ. Detecting endometrial cancer. The Obstetrician & Gynaecologist. 2021 Apr;23[2]:103–12. Doi: https://doi.org/10.1111/tog.12722
  7. Song YJ, Kim HG, Yoon HJ, Choi KU, Suh DS, Kim KH. Preoperative Haematologic Markers for the Differentiation of Endometrial Cancer from Benign Endometrial Lesions in Postmenopausal Patients with Endometrial Masses. Cancer Manag Res. 2023; 15:1111–21. Doi: https://doi.org/10.2147/CMAR.S430013
  8. Mleko M, Pitynski K, Pluta E, Czerw A, Sygit K, Karakiewicz B, et al. Role of systemic inflammatory reaction in female genital organ malignancies – state of the art. Cancer Management and Research. Dove Medical Press Ltd; 2021. p. 5491–508. Doi: https://doi.org/10.2147/CMAR.S312828
  9. Cummings M, Merone L, Keeble C, Burland L, Grzelinski M, Sutton K, et al. Preoperative neutrophil:lymphocyte and platelet:lymphocyte ratios predict endometrial cancer survival. Br J Cancer. 2015 Jul 14;113[2]:311–20. Doi: https://doi.org/10.1038/bjc.2015.200
  10. Acmaz G, Aksoy H, Unal D, Ozyurt S, Cingillioglu B, Aksoy U. et al. Are neutrophil/lymphocyte and platelet/lymphocyte ratios associated with endometrial precancerous and cancerous lesions in patients with abnormal uterine bleeding? Asian Pacific Journal of Cancer Prevention. 2014;15[4]:1689–92. doi: https://doi.org/10.7314/APJCP.2014.15.4.1689
  11. Tian Y, Zhang Y, Tang X, Liu J, Huang Q, Chen Y, et al. Analysis of characteristics of peripheral blood lymphocytes in endometrial carcinoma: a single-center study based on five-year clinical data. BMC Cancer. 2024 Dec 1;24[1]:1184. Doi: https://doi.org/10.1186/s12885-024-12938-8.
  12. Aydoğmuş H, Gençdal S, Kolsuz Z, Elmalı F, Aydoğmuş S, Kelekçi S. Is there a relationship between systemic inflammatory markers and abnormal uterine bleeding in unclassifiable cases according to the PALM-COEIN system? Clin Exp Obstet Gynecol. 2019;46[5]:752–6. Doi: https://doi.org/10.12891/ceog4747.2019
  13. Constantine GD, Kessler G, Graham S, Goldstein SR. Increased incidence of endometrial cancer following the women’s health initiative: An assessment of risk factors. J Womens Health. 2019 Feb 1;28[2]:237–43. Doi: https://doi.org/10.1089/jwh.2018.6956.
  14. Stachowicz N, Smoleń A, Ciebiera M, Łozinski T, Poziemski P, Borowski D, et al. Risk assessment of endometrial hyperplasia or endometrial cancer with simplified ultrasound-based scoring systems. Diagnostics. 2021 Mar 1;11[3]. Doi: https://doi.org/10.3390/diagnostics11030442
  15. Forman M, Mangini L, Thelus-Jean R, Hayward M. Life-course origins of the ages at menarche and menopause. Adolesc Health Med Ther. 2013 Jan;1. Doi: https://doi.org/10.2147/ahmt.s15946.
  16. Cakmak B, Gulucu S, Aliyev N, Ozsoy Z, Nacar M, Koseoglu D. Neutrophil-lymphocyte and platelet-lymphocyte ratios in endometrial hyperplasia. Obstet Gynecol Sci. 2015;58[2]:157. Doi: https://doi.org/10.5468/ogs.2015.58.2.157
  17. Zhang H, Liang K, Ke L, . Clinical application of red cell distribution width, mean platelet volume, and cancer antigen 125 detection in endometrial cancer. J Clin Lab Anal. 2020 Aug 1;34[8]. Doi: https://doi.org/10.1002/jcla.23309.
  18. Muangto T, Mairaing K, Poomtavorn Y, Thaweekul Y, Punyashthira A, Nopwaree Chantawong N, et al. Study on Preoperative Neutrophil/Lymphocyte [NLR] and Platelet/Lymphocyte Ratio [PLR] as a Predictive Factor in Endometrial Cancer. Asian Pacific Journal of Cancer Prevention. 2022;23[10]:3317–22. Doi: https://doi.org/10.31557/APJCP.2022.23.10.3317.
  19. Marin AG, Filipescu AG, Petca RC, Vlădăreanu R, Petca A. Clinical Correlations between Serological Markers and Endometrial Cancer. Cancers [Basel]. 2024 May 1;16[10]. Doi: https://doi.org/10.3390/cancers16101935
  20. Qin L. The predictive value of NLR, PLR and MLR in the differential diagnosis of benign uterine diseases and endometrial malignant tumors. Discover Oncology. 2024 Dec 1;15[1]. Doi: https://doi.org/10.1007/s12672-024-00956-8
  21. Temur M, Taşgöz FN, Çakmak BD, Çift T, Üstünel S, Korkmazer E et al. Relationship between endometrial thickness and neutrophil/lymphocyte ratio with endometrial malignancy in 386 postmenopausal uterine bleeding cases. Journal of Obstetrics and Gynecological Investigations. 2018;1[1]:29–34. Doi: https://doi.org/10.5114/jogi.2018.77761
  22. Dong Y, Cheng Y, Wang J. The ratio of neutrophil to lymphocyte is a predictor in endometrial cancer. Open Life Sci. 2019;14[1]. doi: https://doi.org/10.1515/biol-2019-0012
  23. Bacanakgil BH, Kaban I, Unal F, Guven R, Sahin E, Yildirim SG. Predictive value of hematological inflammatory markers in endometrial Neoplasia. Asian Pacific Journal of Cancer Prevention. 2018 Jun 1;19[6]:1529–32. Doi: https://doi.org/10.22034/APJCP.2018.19.6.1529.
  24. Huo D. Significance of the neutrophil-lymphocyte ratio, lymphocyte-monocyte ratio, and platelet-lymphocyte ratio in peripheral blood for endometrial cancer. Am J Transl Res. 2024;16[11]:6689–98. Doi: https://doi.org/10.62347/QNHR2387.
  25. Saccardi C, Spagnol G, Bonaldo G, Marchetti M, Tozzi R, Noventa M. New Light on Endometrial Thickness as a Risk Factor of Cancer: What Do Clinicians Need to Know? Cancer Management and Research. Dove Medical Press Ltd; 2022. p. 1331–40. Doi: https://doi.org/10.2147/CMAR.S294074

Authors

Raghad Waadallah Younis

Ninevah Health Directorate

Raida Al-Wazzan

Department of Obstetrics and Gynecology, College of Medicine, University of Mosul, Mosul, Iraq

Identifiers

DOI: 10.33899/acmm.v48.i1.62889

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1.
Evaluation of Hematological Inflammatory Markers in Differentiating Benign from Malignant Endometrial Lesions in Women with Abnormal Uterine Bleeding. Ann. coll. Med. Mosul [Internet]. 2026 Jul. 1 [cited 2026 Jul. 18];48(1):100-5. Available from: https://mmed.uomosul.edu.iq/index.php/mmed/article/view/62889

How to Cite

1.
Evaluation of Hematological Inflammatory Markers in Differentiating Benign from Malignant Endometrial Lesions in Women with Abnormal Uterine Bleeding. Ann. coll. Med. Mosul [Internet]. 2026 Jul. 1 [cited 2026 Jul. 18];48(1):100-5. Available from: https://mmed.uomosul.edu.iq/index.php/mmed/article/view/62889