What are the sensitivity, specificity, and reliability of the bimanual pelvic examination?
• Reference standard. Rationale: Histology or, at the least, intraoperative visualization, is the recognized reference standard for ovarian or other adnexal pathology. Studies given credit if all subjects underwent this reference standard (documented followup acceptable in screening studies). • Verification bias. Rationale: If either all or a random sample of test negative subjects do not undergo the reference standard test, significant overestimation of test sensitivity can occur. Studies given credit if all patients underwent reference standard; alternative standards (such as predefined followup) were allowed for screening studies. • Test reliability/variability. Rationale: Inter- and intraobserver variability can, at least, affect the precision of estimates of test characteristics (if random), or can bias results in one direction or the other (if systematic). Studies given credit if test reliability/variability were measured, other studies measuring it were referenced, or if it was
