부산대학교 도서관

Diagnosing the cause of pelvic pain in women is not simple; clinical, laboratory, operative, and histopathological methods may be used to make the diagnosis. To evaluate the accuracy of clinical diagnosis by primary care physicians, 95 women with pelvic pain were studied. Sixty-three percent of the group were initially diagnosed by their primary care physicians; 33 percent, in an emergency department; and 4 percent, in hospital wards. The patients were referred to one of three gynecologists for laparoscopy (viewing the internal organs with a fiberoptic tube) or laparotomy (surgical opening of the abdomen). Biopsy specimens were evaluated independently by three pathologists. The diagnostic accuracy of the primary care physicians and gynecologists was then compared with results from histopathological analysis only (PATH-PID) or from visual inspection plus histopathology (ALL-PID). The diagnostic criteria for pelvic inflammatory disease (an infection of the uterus, fallopian tubes, and ligaments); endometritis (inflammation of the uterine lining); and salpingitis (inflammation of the fallopian tubes) are presented. Results showed that the diagnostic accuracy of gynecologists and primary care physicians was no greater than the chance level, except when gynecologists' diagnoses were compared with ALL-PID. Using ALL-PID or PATH-PID as the standard, gynecologists' ability to correctly diagnose pelvic inflammatory disease when it was present was 74 percent, and to correctly diagnose its absence, 67 percent. A diagnosis of salpingitis via laparoscopy had a sensitivity (true positive results) of 50 percent and a specificity (true negatives) of 80 percent. Agreement among diagnoses based on clinical, visual, and histopathological evidence was rather poor; the reasons for this are discussed. Laparoscopy, with biopsy of the endometrium or fallopian tube ending if no signs of disease are apparent, seems the best approach to diagnosing pelvic inflammatory disease. (Consumer Summary produced by Reliance Medical Information, Inc.)