Accuracy of the pelvic examination in detecting adnexal masses

Abstract

Objective: To estimate sensitivity, specificity, positive predictive value, Youden J statistic, and likelihood ratio of pelvic examination in adnexal assessment under ideal circumstances.

Methods: One hundred forty women consented to have pelvic examinations under general anesthesia before laparoscopy or laparotomy. They were assigned to examiners masked to indications for surgery, including attending gynecologists, gynecology residents, and medical students. Surgeons' findings were compared with examiners' findings. Variables assessed included adnexal diameter, presence of adnexal masses, and effect modifiers such as examiner experience and body mass index.

Results: Forty-nine left adnexal and 33 right adnexal masses were found during surgery. Examiners tended to underestimate adnexal size. Sensitivity of pelvic examinations for detecting left adnexal masses was 0.23-0.36 and for right adnexal masses was 0.15-0.28. Positive predictive value was low for left adnexal masses (0.50-0. 69) and right adnexal masses (0.26-0.39). Differences among examiner groups were not statistically significant. Patient obesity noticeably reduced detection of adnexal masses on either side.

Conclusion: Bimanual pelvic examination has marked limitations for evaluating adnexa, even with ideal circumstances. Experience during postgraduate training in gynecology did not seem to improve examination accuracy. Patient characteristics such as obesity, uterine size, and abdominal scars limit the accurate palpation of the adnexa.