CONTEXT:
An
annual bimanual pelvic examination remains widely recommended for
healthy women, but its inclusion may discourage attendance. Our goal was
to determine the accuracy of the pelvic examination as a screening test
for ovarian cancer and to distinguish benign from malignant lesions.
EVIDENCE ACQUISITION:
PubMed
was searched to identify studies evaluating the accuracy of the
bimanual pelvic examination for ovarian cancer diagnosis. Data regarding
study design, study quality, and test accuracy were abstracted.
Heterogeneity was evaluated and meta-analysis performed where
appropriate, including bivariate receiver operating characteristic
curves.
EVIDENCE SYNTHESIS:
Eight
studies in screening populations (
n=36,599) and seven studies in
symptomatic patients (
n=782) were identified. Search was completed in
November 2013; included studies were published between 1988 and 2009.
Screening studies were
homogeneous; the summary estimates of sensitivity
and specificity of the pelvic examination as a screening test for
ovarian cancer were 0.44 and 0.98 (positive likelihood ratio, 24.7;
negative likelihood ratio, 0.57). For distinguishing benign versus
malignant lesions, there was considerable
heterogeneity, with a range of
sensitivity from 0.43 to 0.93 and specificity from 0.53 to 0.91.
CONCLUSIONS:
The
bimanual pelvic examination lacks accuracy as a screening test for
ovarian cancer and as a way to distinguish benign from malignant
lesions. In a typical screening population, the positive predictive
value of an abnormal pelvic examination is only 1% (95% CI=0.67%, 3.0%).
Its inclusion in a health maintenance examination cannot be justified
on the basis of using it to screen for ovarian cancer.
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