Association of systemic inflammatory markers with endometrioma diagnosis and Douglas infiltration: a retrospective analysis

Hamza Yildiz, Kasim Akay, Gorkem Ulger, Hakan Aytan, Gürkan Yazıcı
In: BMC Women's Health · 2026 · doi:10.1186/s12905-026-04859-4 · W7211958975
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This retrospective analysis found that systemic inflammatory markers, particularly SIRI, effectively distinguish endometriomas from other benign ovarian cysts, while PLR shows potential for predicting Douglas infiltration.

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This retrospective study analyzed hematological inflammatory markers in 480 patients undergoing surgery for benign ovarian cysts to determine their utility in differentiating endometriomas from other cyst types. The results indicated that neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, systemic immune-inflammation index, and systemic inflammation response index were significantly elevated in the endometrioma group compared to controls. Specifically, the systemic inflammation response index demonstrated the highest predictive power for distinguishing endometriomas, while the platelet-lymphocyte ratio showed potential value in identifying patients with Douglas infiltration. This paper is centrally about endometriosis — specifically focusing on the diagnostic association of systemic inflammatory markers with endometrioma presence and deep infiltrating disease.

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Abstract

This study sought to examine the function of hematological inflammatory markers in differentiating endometrioma from other benign ovarian cysts prior to surgery and in individuals with Douglas infiltration. The study was designed retrospectively and included 480 patients (321 endometrioma, 159 non-endometrioma) who were operated on for benign ovarian cysts at Mersin University Hospital between January 1, 2004, and March 1, 2024. Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), Pan-immune inflammation value (PIV), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) were analyzed as hematological inflammatory markers. Additionally, the indices were evaluated in patients with Douglas infiltration, and ROC analysis was conducted to determine their predictive power. The average age of patients with endometrioma did not show a significant difference compared to the average of patients with other benign ovarian cysts (39.0 vs. 40.0 years, p = 0.174). NLR, PLR, SII, and SIRI were significantly higher in the endometrioma group ( p < 0.001). SIRI had the highest value (0.894) in distinguishing endometrioma from other benign ovarian cysts. Douglas infiltration was found to be significantly high with SII, PIV, and PLR having AUCs of 0.580, 0.567, and 0.564, respectively. Hematological inflammatory markers, particularly SIRI, were found to be useful in distinguishing endometriomas from other benign ovarian cysts, and PLR was identified as a potential non-invasive biomarker when analyzing its predictive power in patients with Douglas infiltration.
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Abstract

Background This study sought to examine the function of hematological inflammatory markers in differentiating endometrioma from other benign ovarian cysts prior to surgery and in individuals with Douglas infiltration.

Materials and methods

The study was designed retrospectively and included 480 patients (321 endometrioma, 159 non-endometrioma) who were operated on for benign ovarian cysts at Mersin University Hospital between January 1, 2004, and March 1, 2024. Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), Pan-immune inflammation value (PIV), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) were analyzed as hematological inflammatory markers. Additionally, the indices were evaluated in patients with Douglas infiltration, and ROC analysis was conducted to determine their predictive power.

Results

The average age of patients with endometrioma did not show a significant difference compared to the average of patients with other benign ovarian cysts (39.0 vs. 40.0 years, p = 0.174). NLR, PLR, SII, and SIRI were significantly higher in the endometrioma group (p < 0.001). SIRI had the highest value (0.894) in distinguishing endometrioma from other benign ovarian cysts. Douglas infiltration was found to be significantly high with SII, PIV, and PLR having AUCs of 0.580, 0.567, and 0.564, respectively.

Conclusion

Hematological inflammatory markers, particularly SIRI, were found to be useful in distinguishing endometriomas from other benign ovarian cysts, and PLR was identified as a potential non-invasive biomarker when analyzing its predictive power in patients with Douglas infiltration. Abbreviations - NLR: - Neutrophil-lymphocyte ratio - PLR: - Platelet-lymphocyte ratio - PIV: - Pan-immune inflammation value - SII: - Systemic immune-inflammation index - SIRI: - Systemic inflammation response index - ROC: - A receiver operating characteristic - AUC: - Area under the curve - MRI: - Magnetic resonance imaging

Acknowledgements

Not applicable. Funding The authors have no relevant financial or non-financial interests to disclose. Author information Authors and Affiliations Corresponding author Ethics declarations Ethics approval and consent to participate This study was performed in line with the principles of the Declaration of Helsinki. The study protocol was approved by the Clinical Research Ethics Committee of Mersin University Rectorate (with the ethics committee decision numbered 2024/624 dated 10/07/2024). Informed consent was obtained from all individual participants included in the study. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Additional information Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/. About this article Cite this article Yildiz, H., Akay, K., Ulger, G. et al. Association of systemic inflammatory markers with endometrioma diagnosis and Douglas infiltration: a retrospective analysis. BMC Women's Health (2026). https://doi.org/10.1186/s12905-026-04859-4 Received: Accepted: Published: DOI: https://doi.org/10.1186/s12905-026-04859-4

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