ABSTRACT Objective To explore the value of platelet count/spleen area and platelet count/spleen diameter ratio for diagnosing esophageal varices(EV) in patients with hepatitis B cirrhosis. Methods A total of 172 consecutive patients with hepatitis B cirrhosis from April 2019 to February 2020 at Beijing Ditan hospital were enrolled. All of them were performed by gastroscope, Blood routine examination and abdominal ultrasonography. Platelet count, spleen length diameter and spleen thickness diameter were collected. PC/SA and PC/SD were calculated. According to gastroscope, the patients were divided into EV group and no EV group. Evaluating the value of PC/SA and PC/SD for diagnosing EV by ROC curve. The diagnostic accuracy of two methods was compared. Results There were 121 patients with EV and 51 patients with no EV. The spleen length diameter and spleen thickness diameter in EV group were significantly larger than those in no EV group (P< 0.001). PC, PC/SA and PC/SD in EV group were significantly lower than those in no EV group (P< 0.001).The AUC of PC/SA for diagnosising EV was 0.846(95%CI: 0.784-0.897). When the optimal cutoff value was 10.29, the sensitivity(Se), specificity(Sp), positive predictive value(PPV) and negative predictive value(NPV) were 79.4%, 76.5%, 88.9% and 60.9% respectively, P<0.001.The AUC of PC/SD was 0.816(95%CI: 0.750-0.871). When the optimal cutoff value was 629.65, Se, Sp, PPV and NPV were 87.6%, 64.7%, 85.5% and 68.7% respectively, P<0.001. The diagnostic accuracy of PC/SA was better than that of PC/SD(Z=2.954, P=0.003). Conclusion PC/SA and PC/SD can be used to screen EV in patients with hepatitis B cirrhosis. PC/SA, with higher accuracy, is worthy of clinical attention and application.