title: A systematic review of the bimanual examination as a test for ovarian cancer.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
authors.affiliation: Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Ebell
authors.affiliation: Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia. Electronic address: ebell@uga.edu.
authors.forename: MaryBeth
authors.initials: M
authors.lastname: Culp
authors.affiliation: Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia.
authors.forename: Krista
authors.initials: K
authors.lastname: Lastinger
authors.affiliation: Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia.
authors.forename: Tara
authors.initials: T
authors.lastname: Dasigi
mesh_terms: D055088:Early Detection of Cancer / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D058869:Gynecological Examination / Q000379:methods* / Q000706:statistics & numerical data*; D006801:Humans; D010051:Ovarian Neoplasms / Q000175:diagnosis*; D012372:ROC Curve; D012680:Sensitivity and Specificity; D016387:Women's Health