Archive for the ‘Gynecology’ Category

Ectopic pregnancy

May 6, 2013

The Rational Clinical Examination Series reviewed 14 original studies about diagnosing ectopic pregnancy and yielded the results in the Table.

For interpreting likelihood ratios, consult McGee (PMID: 12213147; PMC1495095); only transvaginal ultrasonography yields helpful accuracy. As frequently happens, the physical examination was much more specific than sensitive.

Sensitivity
(%)
Specificity
(%)
LR+ LR-
cervical motion tenderness 45 91 4.9 0.62
peritoneal findings* 23 to 27 94 to 95 4.2 to 4.5 0.78 to 0.81
adnexal mass 9 96 2.4 0.94
adnexal tenderness 61 65 1.9 0.57
transvaginal ultrasonography 88 99 111 0.12
* Only two studies. Did not pool

Reference

Crochet JR, Bastian LA, & Chireau MV (2013). Does this woman have an ectopic pregnancy?: the rational clinical examination systematic review. JAMA : the journal of the American Medical Association, 309 (16), 1722-9 PMID: 23613077

Predictive Value of Symptoms for Early Detection of Ovarian Cancer

January 29, 2010

The current study validates a prior symptom index developed by Goff (PMID: 17154394) and consensus critiera for prompting testing for ovarian cancer promoted by the Gynecologic Cancer Foundation (GCF), the Society of Gynecologic Oncologists (SGO), and the American Cancer Society (ACS). The current study reports test accuracy similar to the prior reports, but the current study adds the analyses that the societies failed to do: projecting the positive predictive values based on a the prevalence of ovarian cancer found in the Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial (PMID: 16260202). Not surprisingly, with such a low prevalence of cancer in the general population, the predictive values of these tests are all less than 1%. This study demonstrates a case of specialty societies prematurely promoting testing for their diseases.

Diagnostic accuracy for symptoms starting within the past year and an estimated prevalence of ovarian cancer of 60 per 100,000 women (0.06 %).
Symptom
(starting in the last year)
Sensitivity
(%)
(early stage – late stage dz)
Specificity (%) Positive predictive value
Pelvic or abdominal pain
49 to 52
97
< 1%
Bloating or feeling full
44 to 58
97
< 1%
Urinary frequency or urgency
30 to 30
96
< 1%
Symptom index (any of the above at least daily for at least 1 week in the last year) PMID: 17154394
62 to 71
95
< 1%
Consensus criteria (any of the above at least daily for at least 1 month in the last year) PMID: 17848663
59 to 69
94
< 1%

Citation

Rossing, M., Wicklund, K., Cushing-Haugen, K., & Weiss, N. (2010). Predictive Value of Symptoms for Early Detection of Ovarian Cancer JNCI Journal of the National Cancer Institute DOI: 10.1093/jnci/djp500