"Identification of Malignancy Risk Factors in Endometrial Pathologies: The Role of Clinical, Laboratory Parameters,...

Postmenopausal bleeding (PMB) and increased endometrial thickness are key clinical indicators that may suggest underlying malignancies. While endometrial biopsy remains the diagnostic gold standard, its invasiveness underscores the need for alternative, noninvasive biomarkers. This study evaluates the potential of clinical, laboratory, and peripheral blood inflammatory indices (PBII) in distinguishing malignant from benign endometrial pathologies.

This retrospective study included 162 patients who underwent endometrial biopsy due to PMB and/or increased endometrial thickness between January 2023 and January 2024. Patients were categorized into benign (n = 134) and malignant (n = 28) groups. Demographic, clinical, and laboratory parameters were collected, PBII parameters were calculated, and comparisons were performed. Logistic regression analyses were conducted to identify independent predictors of malignancy.

Malignant cases were significantly associated with older age (p < 0.001), longer postmenopausal duration (p = 0.002), higher body mass index (BMI) (p = 0.018), and greater endometrial thickness (p = 0.042) compared to benign cases. Hemoglobin levels were significantly lower (p = 0.022), while neutrophil (p < 0.001) and monocyte (p = 0.042) counts were notably higher in malignant cases. Among PBII parameters, neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), pan-immune-inflammation value (PIV), and systemic inflammation response index (SIRI) were significantly elevated (p < 0.001 for all). Multivariate analysis identified older age (p < 0.001), lower hemoglobin (p = 0.016), higher neutrophil count (p = 0.030), and increased PIV (p = 0.022) as independent predictors of malignancy.

Integrating clinical and laboratory parameters with PBII, particularly PIV, may be a valuable, noninvasive tool for the early detection and risk stratification of endometrial malignancies. This approach could enhance diagnostic accuracy, reduce the need for invasive biopsies, and improve patient management.