Improved diagnostic performance for the diagnosis of polycystic ovary syndrome using age-stratified criteria

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Authors:

Asima K. Ahmad, M.D., M.P.H., Molly Quinn, M.D., Chia-Ning Kao, B.S., M.S., Eleni Greenwood, M.D., Marcelle I. Cedars, M.D., Heather G. Huddleston, M.D.

Abstract:

Objective

To determine optimal criteria for polycystic ovary morphology.

Design

Cross-sectional study.

Setting

Multidisciplinary polycystic ovary syndrome (PCOS) clinic at a tertiary academic center.

Patient(s)

Subjects with PCOS were seen between 2006 and 2015 and met PCOS 1992 National Institutes of Health criteria. Controls were from the Ovarian Aging (OVA) study (2006–2011), a longitudinal study including healthy women with regular menstrual cycles.

Intervention(s)

Clinical data collection.

Main Outcome Measure(s)

Follicle number per ovary (FNPO) and ovarian volume (OV).

Result(s)

A total of 245 subjects with PCOS and 756 OVA study subjects were included in the FNPO analysis and had a mean (± SD) FNPO of 22.6 ± 12.4 and 10 ± 5.3, respectively. Receiver operating characteristic curves were created for both FNPO and OV and analyzed across age group categories (25 to <30, 30 to <35, and 35 to <40 years). Youden's and minimum distance (d) were used to compare efficacies of FNPO and OV thresholds. The optimal threshold for distinguishing PCOS from OVA controls was FNPO > 13. There was a decreasing trend in FNPO threshold with increasing age group (>15, >14, and >12, respectively). A total of 297 PCOS subjects and 756 OVA study subjects were included in the OV analysis and had a mean maximum OV of 10 ± 5 cm3 and 6.5 ± 5 cm3, respectively. The overall threshold was OV > 6.75 cm3, with a trend toward decreasing OV with increase in age group (>8.5, >7, and >6.25 cm3, respectively).

Conclusion(s)

Our findings reflect that age-stratified thresholds demonstrate superior diagnostic performance, with an improved balance of sensitivity and specificity compared with a single threshold. We propose age-specific thresholds for better diagnostic performance.


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