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Re: How do you approach this one?From: art fougner, md (evsono@pipeline.com)Sun Jan 15 16:33:24 2006
Pelvic exam, even under anesthesia, is rather insensitive for adnexal masses... Int J Gynaecol Obstet. 2005 Jan;88(1):84-8. Limitations of the pelvic examination for evaluation of the female pelvic organs. Padilla LA, Radosevich DM, Milad MP. Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of New Mexico, Albuquerque, NM 87102, USA. padi0013@tc.umn.edu OBJECTIVE: To assess factors influencing an accurate pelvic examination under the best possible circumstances. METHODS: Before undergoing laparoscopy or laparotomy, 84 women under general anesthesia underwent pelvic examinations by an attending gynecologist, a gynecology resident, and a medical student blinded to the indication for surgery. Surgical findings were compared with the examiners' findings. Dependent variables (uterine size, uterine contour, and presence of adnexal masses) and effect modifiers (examiner experience and body mass index) were analyzed. RESULTS: The overall pelvic examination was accurate 70.2% of the time for attending gynecologists, 64.0% for residents, and 57.3% for medical students. The sensitivity to detect adnexal masses was much lower than the sensitivity to assess uterine size or uterine contour. Obesity noticeably reduced detection of adnexal masses. CONCLUSION: The bimanual examination appears to be a limited screening test for the female upper genital tract even under the best possible circumstances. Uterine assessment appears to be more accurate than adnexal assessment. PMID: 15617719 [PubMed - indexed for MEDLINE] 2: Obstet Gynecol. 2000 Oct;96(4):593-8. Accuracy of the pelvic examination in detecting adnexal masses. Padilla LA, Radosevich DM, Milad MP. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Minnesota, Minneapolis, Minnesota 55455, USA. padi0013@tc.umn.edu 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. Art
At Sun, 15 Jan 2006, Raymond Stephen wrote:
>
-- art fougner, md
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