Accuracy of the pelvic examination in detecting adnexal masses

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 unde r general anesthesia before laparoscopy or laparotomy. They were assigned t o examiners masked to indications for surgery, including attending gynecolo gists, gynecology residents, and medical students. Surgeons' findings were compared with examiners' findings. Variables assessed included adnexal diam eter, presence of adnexal masses, and effect modifiers such as examiner exp erience and body mass index. Results: Forty-nine left adnexal and 33 right adnexal masses were found dur ing surgery. Examiners tended to underestimate adnexal size. Sensitivity of pelvic examinations for detecting left adnexal masses was 0.23-0.36 and fo r 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). Diff erences among examiner groups were not statistically significant. Patient o besity noticeably reduced detection of adnexal masses on either side. Conclusion: Bimanual pelvic examination has marked limitations for evaluati ng adnexa, even with ideal circumstances. Experience during postgraduate tr aining in gynecology did not seem to improve examination accuracy. Patient characteristics such as obesity, uterine size, and abdominal scars limit th e accurate palpation of the adnexa. (Obstet Gynecol 2000;96:593-8. (C) 2000 by The American College of Obstetricians and Gynecologists.).