Is there any value in bimanual pelvic examination as a screening test.
OBJECTIVE
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.
Grover
S R
SR
Department of Obstetrics and Gynaecology, University of Melbourne, Royal Women's Hospital, Carlton, VIC.
Quinn
M A
MA
D000290:Adnexa Uteri / Q000000981:diagnostic imaging; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018394:CA-125 Antigen / Q000097:blood; D005260:Female; D006801:Humans; D007889:Leiomyoma / Q000175:diagnosis; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000517:prevention & control*; D010173:Palpation; D014463:Ultrasonography; D014594:Uterine Neoplasms / Q000175:diagnosis; D014599:Uterus / Q000000981:diagnostic imaging
D018394:CA-125 Antigen