A systematic review of the bimanual examination as a test for ovarian cancer

Mark H. Ebell, Marybeth Culp, Krista Lastinger, Tara Dasigi

Research output: Contribution to journalReview article

13 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)350-356
Number of pages7
JournalAmerican Journal of Preventive Medicine
Volume48
Issue number3
DOIs
StatePublished - Mar 1 2015
Externally publishedYes

Fingerprint

Gynecological Examination
Ovarian Neoplasms
PubMed
ROC Curve
Population
Meta-Analysis
Sensitivity and Specificity
Health

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Epidemiology
  • Medicine(all)

Cite this

A systematic review of the bimanual examination as a test for ovarian cancer. / Ebell, Mark H.; Culp, Marybeth; Lastinger, Krista; Dasigi, Tara.

In: American Journal of Preventive Medicine, Vol. 48, No. 3, 01.03.2015, p. 350-356.

Research output: Contribution to journalReview article

Ebell, Mark H. ; Culp, Marybeth ; Lastinger, Krista ; Dasigi, Tara. / A systematic review of the bimanual examination as a test for ovarian cancer. In: American Journal of Preventive Medicine. 2015 ; Vol. 48, No. 3. pp. 350-356.
@article{acfab49ad47f46c99097d405b78e9cf5,
title = "A systematic review of the bimanual examination as a test for ovarian cancer",
abstract = "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.",
author = "Ebell, {Mark H.} and Marybeth Culp and Krista Lastinger and Tara Dasigi",
year = "2015",
month = "3",
day = "1",
doi = "10.1016/j.amepre.2014.10.007",
language = "English (US)",
volume = "48",
pages = "350--356",
journal = "American Journal of Preventive Medicine",
issn = "0749-3797",
publisher = "Elsevier Inc.",
number = "3",

}

TY - JOUR

T1 - A systematic review of the bimanual examination as a test for ovarian cancer

AU - Ebell, Mark H.

AU - Culp, Marybeth

AU - Lastinger, Krista

AU - Dasigi, Tara

PY - 2015/3/1

Y1 - 2015/3/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84926181803&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84926181803&partnerID=8YFLogxK

U2 - 10.1016/j.amepre.2014.10.007

DO - 10.1016/j.amepre.2014.10.007

M3 - Review article

VL - 48

SP - 350

EP - 356

JO - American Journal of Preventive Medicine

JF - American Journal of Preventive Medicine

SN - 0749-3797

IS - 3

ER -