Diagnostic Value of Simple Ultrasound Features and Inflammatory Markers in Postmenopausal Ovarian Cysts

Background: The management of ovarian cysts in postmenopausal women is still a diagnostic dilemma. Although ultrasound is the diagnostic cornerstone of the initial assessment, it is limited by its interpretation in cases without clear morphological features of malignancy. Objectives: The aim of this study was to assess whether the addition of grayscale ultrasound features with inflammatory markers including the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) can improve diagnostic accuracy in the identification of malignant ovarian lesions as compared to benign cysts in postmenopausal women. Methods: A total of 103 surgically removed adnexal masses were examined retrospectively. Ultrasound morphology was categorized to either simple or complex while NLR and PLR were calculated from preoperative full blood counts. The reference standard was histopathology. Results: Of the 103 cysts taken out, 74 cysts (71.8%) were benign while 29 cysts (28.2%) were malignant. Complex morphology was shown by all malignant lesions. NLR values in malignancy vs. benignancy showed a mean NLR of 4.96 ± 2.3 in the malignant cases, while it was 2.56 ± 1.2 in the benign cases (p < 0.001). In a similar fashion, the PLR was 198.4 ± 45.1 in malignant compared to 134.2 ± 32.7 in benign cases (p < 0.001). In the group of complex cysts (n = 52), NLR and PLR were compared to differentiate between malignant and benign lesions. In logistic regression, complex morphology was an independent predictor of malignancy, while NLR showed a positive, non-significant trend; PLR was not independently associated. Conclusions: Use of NLR and PLR in combination with grayscale ultrasonographic morphology improves the diagnostic characterization of postmenopausal women with adnexal masses. This easy, cost-effective method might aid in better triage and surgery planning.