Usefulness of hematological parameters for differential diagnosis of endometriomas in adolescents/young adults and older women

Abstract

Background Inflammatory processes have been considered to be involved in the pathogenesis of endometriosis. However, the predictive role of inflammatory hematological parameters in endometriosis is not clear. The aim of this study was to analyze the clinical value of hematologic markers in the differential diagnosis of endometriomas in younger and older reproductive age women. Materials and methods A retrospective chart review was done for 502 patients who underwent surgery: 267 with endometriomas (endometrioma group) and 235 with other benign adnexal cysts (control group). Patients were placed into subgroups as younger (adolescents/young adults, aged <25 years) and older (aged ≥25 years) women. Total and differential white blood cell count, neutrophil-to-lymphocyte ratio, platelet indices and platelet-to-lymphocyte ratio (PLR) were evaluated with receiver operating characteristic curve analysis for differential diagnosis of endometriomas. Results The mean serum levels of PLR, plateletcrit (PCT), platelet count and CA-125 (reference range below 35 IU/mL) were significantly higher in the endometrioma group (p < 0.001). The area under the curve (AUC) for CA-125 was 0.85 [95% confidence interval (CI), 0.82–0.88] (p < 0.001) for the entire group. However, platelet count, PLR, and PCT showed poor discriminative ability for detecting endometriomas with AUC values of 0.59 (95% CI, 0.55–0.65, p < 0.001), 0.58 (95% CI, 0.53–0.63, p = 0.002) and 0.61 (95% CI, 0.56–0.66, p < 0.001), respectively. In age-stratified analysis, these platelet indices had also low diagnostic performance in both age groups. Conclusions Hematologic markers do not adequately differentiate ovarian endometriomas from other benign cysts in neither adolescents/young adults nor older women.

Assessment of Coagulation Parameters in Women Affected by Endometriosis: Validation Study and Systematic Review of the Literature

“…Three studies showed that neutrophil count was higher in patients with endometriosis than in women without the disease [9,23,31]. On the other hand, three studies showed no significant difference among groups, either when considering OMAs or in non-OMA patients [14,25,28]. Importantly, our present study confirmed a significantly higher neutrophil count in patients with endometriosis.…”

“…Among six studies investigating PLR [9,14,24,25,28,30], results obtained were more consistent. Four groups reported a significantly higher PLR in women with endometriosis [9,24,28,30]. In our previous case-control study [14], considering the various manifestations of endometriosis separately, we found that women with stage I to II endometriosis had significantly higher PLR than those with stage III to IV disease.…”

“…The search revealed n = 17 studies eligible for inclusion in this systematic review. Of these, n = 14 were finally included [ 9 , 12 , 13 , 14 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. A flow diagram of the systematic review is shown in Figure 2 (PRISMA template).…”

“…Kim and coworkers, comparing stage I-II to stage III-IV endometriosis cases who underwent laparoscopic conservative surgery for OMAs, did not find any difference in NLR [27]. Among six studies investigating PLR [9,14,24,25,28,30], results obtained were more consistent. Four groups reported a significantly higher PLR in women with endometriosis [9,24,28,30].…”

“…Among eight studies investigating the lymphocyte count [9,14,[23][24][25]27,28,31], only three of them reported a significantly lower mean cell count in endometriosis compared to controls [9,23,31], and no correlation between the stage of endometriosis and the lymphocyte count was observed by Kim et al [27]. Two studies found no difference between cases and controls in terms of NLR [25,28]. In our previous study, we found no difference in NLR between women with endometriosis and controls, although, when considering the various manifestations of endometriosis separately, a significant difference among groups emerged, as women with peritoneal lesions had lower NLR compared to patients without this form [14].…”