Evaluation of Derived Hematological Markers across Various Groups of Bethesda Cervical Cytology

Abstract Aim: To evaluate the relationship between Bethesda Cervical Cytology categories and selected hematological indices and to introduce a new composite marker, the cervical inflammation index (CII; neutrophil-to-lymphocyte ratio [NLR] + platelet-to-lymphocyte ratio [PLR] + systemic immune-inflammation index [SII]). Materials and Methods: This retrospective, record-based study included cervical cytology smears reported under the Bethesda System (The Bethesda System for Reporting Cervical Cytology) between January 2022 and June 2025. Cases were grouped as negative for intraepithelial lesions or malignancy (NILM), NILM with dense inflammation, NILM with bacterial vaginosis (BV), NILM with Trichomonas vaginalis , NILM with candidiasis, low-risk lesions, and high-risk lesions. Hematological parameters included inflammatory ratios (NLR, monocyte-to-lymphocyte ratio [MLR], PLR, and eosinophil-to-lymphocyte ratio), composite indices (SII, pan-immune-inflammation value [PIV], and CII), and platelet indices (plateletcrit, mean platelet volume [MPV], and platelet distribution width [PDW]). After applying exclusion criteria, 455 cases (65 per group) were analyzed. Results: As the data were non-normally distributed, results are presented as median (interquartile range). Significant variation across Bethesda groups was observed for NLR, MLR, SII, CII, MPV, and PDW ( P = 0.041, 0.004, 0.047, 0.032, 0.019, and 0.003, respectively). NLR, MLR, SII, and CII were significantly higher in high-risk than in low-risk lesions. MLR also differed significantly between high-risk lesions and NILM with BV. PDW was elevated in both low- and high-risk lesions compared with NILM with BV. Receiver operating characteristic analysis showed a meaningful predictive value of NLR, MLR, SII, and CII for differentiating low- and high-risk lesions, with MLR showing the highest area under the curve (0.658, P = 0.001). Conclusion: Derived hematological parameters show distinct variation across Bethesda categories, with several indices elevated in high-risk lesions. These easily obtainable markers may serve as cost-effective adjuncts for patient stratification and contribute to the early detection of premalignant or malignant cervical lesions, pending further validation.