IS THERE ANY VALUE IN BIMANUAL PELVIC EXAMINATION AS A SCREENING-TEST

Objectives: To assess the place of bimanual pelvic examination as a ro utine procedure in healthy women. Methods: 2623 healthy, asymptomatic volunteers (mean age, 51 years; range, 25-92 years) underwent pelvic e xamination as part of an ovarian cancer screening program. The presenc e of a bulky or fibroid uterus and adnexal abnormality was noted. Pelv ic ultrasonography was used to investigate adnexal abnormalities and w as also performed in all women with an elevated serum CA-125 antigen l evel (> 35 U/mL). Laparoscopy or laparotomy was performed as clinicall y indicated.Results: A bulky or fibroid uterus was detected in 12.9% o f 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 malign ancy was 99.9%. No ovarian malignancies were identified at initial scr eening. Conclusions: This ''routine'' procedure is undertaken in the b elief that it serves a screening purpose. The detection of benign uter ine abnormality is of no dear benefit as progression to malignancy is rare. Bimanual pelvic examination is of questionable value as a screen ing strategy in view of the low incidence of ovarian cancer in healthy women, and the relatively high prevalence (1.5%) of relatively unimpo rtant adnexal abnormalities.