title: Follicle number, not assessments of the ovarian stroma, represents the best ultrasonographic marker of polycystic ovary syndrome.
abstract: OBJECTIVE
  To compare the diagnostic potential of ultrasonographic markers of ovarian morphology, used alone or in combination, to predict polycystic ovary syndrome (PCOS).
  
  
  METHODS
  A diagnostic test study using cross-sectional data collected from 2006-2011.
  
  
  METHODS
  Academic hospital and clinical research unit.
  
  
  METHODS
  Eighty-two women with PCOS and 60 healthy female volunteers.
  
  
  METHODS
  None.
  
  
  METHODS
  Follicle number per ovary (FNPO), ovarian volume (OV), follicle number per single cross-section (FNPS), follicle distribution pattern, stromal area, ovarian area, stromal-to-ovarian area ratio (S:A), and stromal index (SI).
  
  
  RESULTS
  Follicle number per ovary best predicted PCOS (R(2) = 67%) with 85% sensitivity and 98% specificity, followed by OV (R(2) = 44%), and FNPS (R(2) = 36%). Neither S:A nor SI had predictive power for PCOS. In combination, FNPO+S:A and FNPO+SI most significantly predicted PCOS (R(2) = 74% vs. 73%, respectively). The diagnostic potentials of OV and FNPS were substantially improved when used in combination (OV+FNPO, R(2) = 55%).
  
  
  CONCLUSIONS
  As a single metric, FNPO best predicted PCOS. Although the addition of S:A or SI improved the predictive power of FNPO, gains were marginal, suggesting limited use in clinical practice. When image quality precludes a reliable estimation of FNPO, measurements of OV+FNPS provide the next closest level of diagnostic potential.
authors.affiliation: Division of Nutritional Sciences, Cornell University, Ithaca, New York.
authors.forename: Jacob P
authors.initials: JP
authors.lastname: Christ
authors.affiliation: Department of Statistical Science, Cornell University, Ithaca, New York.
authors.forename: Amy D
authors.initials: AD
authors.lastname: Willis
authors.affiliation: Division of Nutritional Sciences, Cornell University, Ithaca, New York.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Brooks
authors.affiliation: Division of Nutritional Sciences, Cornell University, Ithaca, New York.
authors.forename: Heidi
authors.initials: H
authors.lastname: Vanden Brink
authors.affiliation: Division of Nutritional Sciences, Cornell University, Ithaca, New York.
authors.forename: Brittany Y
authors.initials: BY
authors.lastname: Jarrett
authors.affiliation: Department of Obstetrics, Gynecology & Reproductive Sciences, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
authors.forename: Roger A
authors.initials: RA
authors.lastname: Pierson
authors.affiliation: Department of Obstetrics, Gynecology & Reproductive Sciences, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
authors.forename: Donna R
authors.initials: DR
authors.lastname: Chizen
authors.affiliation: Division of Nutritional Sciences, Cornell University, Ithaca, New York. Electronic address: MEL245@cornell.edu.
authors.forename: Marla E
authors.initials: ME
authors.lastname: Lujan
mesh_terms: D000293:Adolescent; D000328:Adult; D002452:Cell Count / Q000379:methods; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006080:Ovarian Follicle / Q000000981:diagnostic imaging* / Q000473:pathology; D010053:Ovary / Q000000981:diagnostic imaging / Q000473:pathology; D011085:Polycystic Ovary Syndrome / Q000000981:diagnostic imaging* / Q000473:pathology; D017154:Stromal Cells / Q000000981:diagnostic imaging / Q000473:pathology; D014463:Ultrasonography; D055815:Young Adult
keywords: Polycystic ovary syndrome; follicle; hyperandrogenism; stroma; ultrasound