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Is there any value in bimanual pelvic examination as a screening test?
Author(s) -
Grover Sonia R,
Quinn Michael A
Publication year - 1995
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.1995.tb139967.x
Subject(s) - medicine , pelvic examination , asymptomatic , abnormality , malignancy , gynecological examination , laparotomy , ovarian cancer , gynecology , adnexal mass , obstetrics , adnexal diseases , physical examination , cancer , laparoscopy , radiology , surgery , psychiatry
Objectives: To assess the place of bimanual pelvic examination as a routine procedure in healthy women. Methods: 2623 healthy, asymptomatic volunteers (mean age, 51 years; range, 25–92 years) underwent pelvic examination as part of an ovarian cancer screening program. The presence of a bulky or fibroid uterus and adnexal abnormality was noted. Pelvic ultrasonography was used to investigate adnexal abnormalities and was also performed in all women with an elevated serum CA‐125 antigen level (> 35 U/mL). Laparoscopy or laparotomy was performed as clinically indicated. Results: A bulky or fibroid uterus was detected in 12.9% of women. The prevalence of abnormal adnexal findings was 1.5%, with a positive predictive value for a subsequent diagnosis of benign adnexal abnormality of 22%. The specificity of vaginal examination for malignancy was 99.9%. No ovarian malignancies were identified at initial screening. Conclusions: This “routine” procedure is undertaken in the belief that it serves a screening purpose. The detection of benign uterine abnormality is of no clear benefit as progression to malignancy is rare. Bimanual pelvic examination is of questionable value as a screening strategy in view of the low incidence of ovarian cancer in healthy women, and the relatively high prevalence (1.5%) of relatively unimportant adnexal abnormalities.