对无症状、平均风险的成年女性进行盆腔检查筛查：美国医师学院临床实践指南的证据报告。

Screening pelvic examinations in asymptomatic, average-risk adult women: an evidence report for a clinical practice guideline from the American College of Physicians.

出版信息

Ann Intern Med. 2014 Jul 1;161(1):46-53. doi: 10.7326/M13-2881.

DOI:10.7326/M13-2881

PMID:24979449

Abstract

BACKGROUND

Pelvic examination is often included in well-woman visits even when cervical cancer screening is not required.

PURPOSE

To evaluate the diagnostic accuracy, benefits, and harms of pelvic examination in asymptomatic, nonpregnant, average-risk adult women. Cervical cancer screening was not included.

DATA SOURCES

MEDLINE and Cochrane databases through January 2014 and reference lists from identified studies.

STUDY SELECTION

52 English-language studies, 32 of which included primary data.

DATA EXTRACTION

Data were extracted on study and sample characteristics, interventions, and outcomes. Quality of the diagnostic accuracy studies was evaluated using a published instrument, and quality of the survey studies was evaluated with metrics assessing population representativeness, instrument development, and response rates.

DATA SYNTHESIS

The positive predictive value of pelvic examination for detecting ovarian cancer was less than 4% in the 2 studies that reported this metric. No studies that investigated the morbidity or mortality benefits of screening pelvic examination for any condition were identified. The percentage of women reporting pelvic examination-related pain or discomfort ranged from 11% to 60% (median, 35%; 8 studies [n = 4576]). Corresponding figures for fear, embarrassment, or anxiety ranged from 10% to 80% (median, 34%; 7 studies [n = 10 702]).

LIMITATION

Only English-language publications were included; the evidence on diagnostic accuracy, morbidity, and mortality was scant; and the studies reporting harms were generally low quality.

CONCLUSION

No data supporting the use of pelvic examination in asymptomatic, average-risk women were found. Low-quality data suggest that pelvic examinations may cause pain, discomfort, fear, anxiety, or embarrassment in about 30% of women.

PRIMARY FUNDING SOURCE

Department of Veterans Affairs.

摘要

背景

即使不需要进行宫颈癌筛查，盆腔检查也常常包含在常规的女性健康检查中。

目的

评估无症状、非妊娠、平均风险的成年女性进行盆腔检查的诊断准确性、获益和危害。不包括宫颈癌筛查。

资料来源

通过 2014 年 1 月的 MEDLINE 和 Cochrane 数据库以及已确定研究的参考文献列表。

研究选择

52 项英文研究，其中 32 项研究包含原始数据。

资料提取

对研究和样本特征、干预措施和结局进行了资料提取。使用已发表的工具评估诊断准确性研究的质量，使用评估人群代表性、工具开发和应答率的指标评估调查研究的质量。

资料综合

2 项报道了这一指标的研究显示，盆腔检查对卵巢癌的阳性预测值小于 4%。没有发现研究调查筛查盆腔检查对任何疾病的发病率或死亡率获益。报道盆腔检查相关疼痛或不适的女性比例为 11%~~60%（中位数为 35%；8 项研究，n=4576）。报道盆腔检查相关恐惧、尴尬或焦虑的女性比例为 10%~~80%（中位数为 34%；7 项研究，n=10702）。