Systemic inflammatory ratios and their added value to cytology in cervical cancer detection: a multicenter study

Cytology-based screening is central to cervical cancer prevention but may underestimate invasive disease. Low-cost adjunctive biomarkers could improve triage, particularly in settings with limited access to advanced diagnostics. We evaluated cytology-histology concordance and the utility of systemic inflammatory indices in women undergoing cervical conization.

This multicenter retrospective study analyzed 1.142 women who underwent conization between 2021 and 2024 across three gynecological departments in Budapest, Hungary. Cytological and histological findings were grouped into four clinically relevant grades. Preoperative neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte (PLR), and lymphocyte-to-monocyte ratios (LMR) were derived from routine blood counts and assessed using non-parametric tests, receiver operating characteristic (ROC) analysis, logistic regression, and Bayesian updating.

Cytology underestimated histological severity in 13.9% of cases and missed 79.6% of invasive cancers (sensitivity 20.4%). NLR was significantly associated with histological outcomes and invasive cancer (p = 0.032), whereas LMR was associated with cytological severity (p = 0.0009). Although discriminatory performance was modest (area under curve (AUC) 0.57-0.60), all markers showed high negative predictive values (>96%). Elevated NLR independently predicted invasive cancer (odds ratio (OR) 2.04, p = 0.036), with cancer prevalence increasing across NLR risk strata.

Complete blood count (CBC)-derived inflammatory markers, particularly NLR and LMR, may support cervical cancer triage strategies as low-cost adjuncts with rule-out potential; however, their limited discriminatory performance precludes their use as standalone diagnostic tools. They may still contribute to risk-adapted decision-making, especially in resource-limited settings, but require further prospective validation within multimodal strategies.