Sellors J, Mahony J, Goldsmith C, Rath D, Mander R, Hunter B, Taylor C, Groves D, Richardson H, Chernesky M
Department of Family Medicine, Joseph Brant Memorial Hospital, Burlington, Ontario, Canada.
Am J Obstet Gynecol. 1991 Jan;164(1 Pt 1):113-20. doi: 10.1016/0002-9378(91)90639-9.
The accuracy of clinical diagnosis for pelvic inflammatory disease was determined in 95 women who presented with pelvic pain to primary care physicians and then were referred to gynecologists. Laparoscopy or laparotomy with endometrial biopsy and fimbrial minibiopsy revealed that prevalence of pelvic inflammatory was 46% (44/95) and positive and negative predictive values of gynecologists were 74% (23/31) and 67% (43/64) (p = 0.0002). If histopathologic diagnosis was the standard, clinical accuracies of the gynecologists were no better than chance (p = 0.43), suggesting an expectation bias for visual diagnosis. Laparoscopy had a sensitivity of 50% (12/24) and a specificity of 80% (40/50) for salpingitis if the standard was fimbrial histopathologic diagnosis (p = 0.01). These results support the routine use of laparoscopy, supplemented when negative by endometrial and fimbrial minibiopsy, to accurately diagnose pelvic inflammatory disease.
对95名因盆腔疼痛前往初级保健医生处就诊，随后转诊至妇科医生处的女性进行了盆腔炎临床诊断准确性的测定。腹腔镜检查或剖腹手术联合子宫内膜活检及输卵管伞端活检显示，盆腔炎患病率为46%（44/95），妇科医生的阳性预测值和阴性预测值分别为74%（23/31）和67%（43/64）（p = 0.0002）。若以组织病理学诊断为标准，妇科医生的临床诊断准确性并不优于随机水平（p = 0.43），提示存在视觉诊断的期望偏倚。若以输卵管伞端组织病理学诊断为标准，腹腔镜检查对输卵管炎的敏感性为50%（12/24），特异性为80%（40/50）（p = 0.01）。这些结果支持常规使用腹腔镜检查，若结果为阴性则辅以子宫内膜和输卵管伞端活检，以准确诊断盆腔炎。
