Improved diagnostic performance for the diagnosis of polycystic ovary syndrome using age-stratified criteria

Abstract

Objective: To determine optimal criteria for polycystic ovary morphology.

Design: Cross-sectional study.

Setting: Multidisciplinary polycystic ovary syndrome (PCOS) clinic at a tertiary academic center.

Patient(s): Subjects with PCOS were seen between 2006 and 2015 and met PCOS 1992 National Institutes of Health criteria. Controls were from the Ovarian Aging (OVA) study (2006-2011), a longitudinal study including healthy women with regular menstrual cycles.

Intervention(s): Clinical data collection.

Main outcome measure(s): Follicle number per ovary (FNPO) and ovarian volume (OV).

Result(s): A total of 245 subjects with PCOS and 756 OVA study subjects were included in the FNPO analysis and had a mean (± SD) FNPO of 22.6 ± 12.4 and 10 ± 5.3, respectively. Receiver operating characteristic curves were created for both FNPO and OV and analyzed across age group categories (25 to <30, 30 to <35, and 35 to <40 years). Youden's and minimum distance (d) were used to compare efficacies of FNPO and OV thresholds. The optimal threshold for distinguishing PCOS from OVA controls was FNPO > 13. There was a decreasing trend in FNPO threshold with increasing age group (>15, >14, and >12, respectively). A total of 297 PCOS subjects and 756 OVA study subjects were included in the OV analysis and had a mean maximum OV of 10 ± 5 cm³ and 6.5 ± 5 cm³, respectively. The overall threshold was OV > 6.75 cm³, with a trend toward decreasing OV with increase in age group (>8.5, >7, and >6.25 cm³, respectively).

Conclusion(s): Our findings reflect that age-stratified thresholds demonstrate superior diagnostic performance, with an improved balance of sensitivity and specificity compared with a single threshold. We propose age-specific thresholds for better diagnostic performance.

Keywords: Cross-sectional; PCOS; diagnosis; follicle number per ovary; ovarian volume.