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

Sep 22, 2026

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Cytology-based screening is central to cervical cancer prevention but can underestimate invasive disease, especially where advanced diagnostics are unavailable. This multicenter retrospective study evaluated cytology–histology concordance and the added value of systemic inflammatory indices in women undergoing conization. Among 1,142 patients (2021–2024) across three gynecological departments, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio were assessed using ROC analysis, logistic regression, and Bayesian updating for risk stratification.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages12

Reading Time30 min

AccessFree to download

Introduction

Conventional cervical cancer screening

Limitations of cytology and need for risk stratification

Methods

Study design and population

Inflammatory indices and statistical approach

Results

Cytology–histology discordance

Associations and predictive performance

Conclusion

Clinical implications for triage strategies

TYPE Original Research PUBLISHED 13 May 2026 DOI 10.3389/fmed.2026.1802477 OPEN ACCESS EDITED BY Yu Ligh Liou, Tsinghua University, China REVIEWED BY Roberto Altamirano, University of Chile, Chile M. Shanthini, Sri Ramakrishna Engineering College, India *CORRESPONDENCE Márton Keszthelyi [keszthelyi.marton@semmelweis.hu](keszthelyi.marton@semmelweis.hu) RECEIVED 02 February 2026 REVISED 15 April 2026 ACCEPTED 22 April 2026 PUBLISHED 13 May 2026 CITATION Vajda G, Lőczi L, Vida B, Merkely P, Sebők B, Bánhidy F, Ács N, Tóth R, Lintner B and Keszthelyi M (2026) Systemic inflammatory ratios and their added value to cytology in cervical cancer detection: a multicenter study. Front. Med. 13:1802477. doi: 10.3389/fmed.2026.1802477 COPYRIGHT © 2026 Vajda, Lőczi, Vida, Merkely, Sebők, Bánhidy, Ács, Tóth, Lintner and Keszthelyi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Systemic inflammatory ratios and their added value to cytology in cervical cancer detection: amulticenter study Gabriella Vajda 1 , 2, Lotti Lőczi 1 , 3, Balázs Vida 1, Petra Merkely 1, Barbara Sebők3, Ferenc Bánhidy 1, Nándor Ács 1, Richárd Tóth 1, Balázs Lintner 1 and Márton Keszthelyi 1* 1Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary, 2Maternity Obstetrics and Gynecology Private Clinic, Budapest, Hungary, 3Workgroup of Research Management, Doctoral School, Semmelweis University, Budapest, Hungary Background: 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. Methods: 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. Results: 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. Conclusion: 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. KEYWORDS biomarkers, cervical cancer screening, conization, cytology–histology discrepancy, lymphocyte-to-monocyte ratio, neutrophil-to-lymphoc

FAQs

Why are systemic inflammatory ratios considered in cervical cancer detection?

Cytology may underestimate invasive disease, and low-cost inflammatory biomarkers could improve triage where advanced diagnostics are limited.

What inflammatory ratios were evaluated and from where were they derived?

Preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) were derived from routine complete blood counts.

How did cytology perform compared with histology in this study?

Cytology underestimated histological severity in 13.9% of cases and missed 79.6% of invasive cancers, with sensitivity 20.4%.

Can NLR and LMR be used as standalone diagnostic tests?

Their discriminatory performance was modest, so they are not suitable as standalone diagnostic tools; they may support risk-adapted decision-making instead.

Sep 22, 2026

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