Objective

To analyze the literature and expose best evidence available regarding the benefit of pelvic examination for women with suspected endometriosis

Methods

the AGREE II and GRADE systems for grading scientific evidence.

Results

Endometriosis is characterized by the heterogeneity in its clinical presentation with many different symptoms reported by patients. In the literature, questioning for each symptom has a high sensitivity, reaching 76–98 %, but lacks specificity (20 – 58 %). The symptom-based approach is limited by its low specificity, the absence of external validation for most of the models developed and the inability to characterize the extent of the disease, which could have major implications in the decision – making process. The latest systematic review and meta-analysis included a total of 30 studies with 4,565 participants, compared the diagnostic performance of several modalities for endometriosis. Physical examination had a pooled sensitivity of 71 % and a specificity of 69 %, with an average diagnostic accuracy of 0.76. Overall, the value of pelvic examination is conferred by its high positive likehood ratio and specificity. Besides its diagnostic value, pelvic examination improves patients’ management by allowing the identification of a possible myofascial syndrome as a differential diagnosis. It also increases the quality of the preoperative workup and influences the quality of surgical excision and decreases the time to diagnosis.

Conclusion

Despite the lack of studies in the primary care context, pelvic examination (vaginal speculum and digital vaginal examination) increases the diagnostic value for suspected endometriosis in association with questioning for symptoms.

中文翻译：

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疑似子宫内膜异位症的女性是否可以通过盆腔检查来改善诊断和管理策略？

客观的

分析文献并揭示关于盆腔检查对疑似子宫内膜异位症女性的益处的最佳证据

方法

用于对科学证据进行分级的 AGREE II 和 GRADE 系统。

结果

子宫内膜异位症的特点是其临床表现具有异质性，患者报告有许多不同的症状。文献中，对每种症状的询问敏感性很高，达到 76-98%，但缺乏特异性 (20-58%)。基于症状的方法受到其低特异性、大多数开发模型缺乏外部验证以及无法表征疾病程度的限制，这可能对决策过程产生重大影响。最新的系统回顾和荟萃分析包括总共 30 项研究，涉及 4,565 名参与者，比较了几种子宫内膜异位症治疗方法的诊断性能。体格检查的汇总敏感性为 71%，特异性为 69%，平均诊断准确性为 0.76。总体而言，盆腔检查的价值在于其高阳性似然比和特异性。除了其诊断价值外，盆腔检查还可以识别可能的肌筋膜综合征作为鉴别诊断，从而改善患者的治疗。它还提高了术前检查的质量，影响手术切除的质量，并缩短了诊断时间。

结论

尽管缺乏初级保健方面的研究，但盆腔检查（阴道窥器和指阴道检查）结合询问症状，增加了疑似子宫内膜异位症的诊断价值。