定期查盆腔检查:美国预防服务工作组的证据报告和系统审查
Janelle M Guirguis-Blake1, Jillian T Henderson2, Leslie A Perdue2
1Department of Family Medicine, University of Washington, Tacoma2Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon.
JAMA
|March 8, 2017
概括
没有证据表明查盆腔检查有助于降低死亡率或发病率. 有限的数据显示妇科疾病的准确性有所变化,卵巢癌和手术等潜在危害的预测值较低.
科学领域:
- 妇科瘤学
- 预防医学
- 诊断的准确性
背景情况:
- 最近宫癌查指南的变化促使重新评估无症状妇女的盆腔检查的作用.
- 美国预防服务工作组 (USPSTF) 要求对妇女健康的查测试进行系统审查.
研究的目的:
- 对查骨盆检查对妇科疾病的健康益处,诊断准确性和危害进行系统的文献审查.
- 根据USPSTF关于无症状妇女的盆腔检查有用性的建议.
主要方法:
- 在2016年8月之前搜索了MEDLINE,PubMed和Cochrane控制试验中心注册表.
- 在选了8678个单一引用和审查了316篇全文文章后,包括9项涉及27630名患者的研究.
- 两位独立审查员使用USPSTF标准评估了研究质量.
主要成果:
- 没有任何试验表明盆腔检查在降低全因死亡率,癌症特异性发病率/死亡率或改善生活质量的有效性.
- 对卵巢癌的诊断准确性的有限证据显示了低的阳性预测值 (PPV) 和高的错误阳性率.
- 对细菌性阴道炎,三毛病和生殖器疹的研究报告了不同的准确性,通常在有症状或高患病率的人群中;卵巢癌查异常发现后的手术率在5%至36%之间.
结论:
- 没有直接证据支持盆腔检查作为查工具的整体益处或危害.
- 在无症状的初级保健机构中,常规查盆腔检查的诊断准确性和危害的证据有限.
- 需要进一步的研究来澄清查盆腔检查的作用和影响.
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