Updated ultrasound criteria for polycystic ovary syndrome: reliable thresholds for elevated follicle population and ovarian volume

• Published in: Human reproduction (Oxford) 2013-05, Vol.28 (5), p.1361-1368
• Main Authors: Lujan, Marla E., Jarrett, Brittany Y., Brooks, Eric D., Reines, Jonathan K., Peppin, Andrew K., Muhn, Narry, Haider, Ehsan, Pierson, Roger A., Chizen, Donna R.
• Format: Article
• Language: English
• Subjects: Adult; Data processing; Female; Humans; Menstrual Cycle; Observer Variation; Ovarian Follicle - diagnostic imaging; Ovary - diagnostic imaging; Ovary - pathology; Polycystic Ovary Syndrome - diagnosis; Polycystic Ovary Syndrome - diagnostic imaging; Reproducibility of Results; ROC Curve; Sensitivity and Specificity; Testosterone - analysis; Ultrasonography; Young Adult
• ISSN: 0268-1161; 1460-2350
• DOI: 10.1093/humrep/det062

STUDY QUESTION Do the ultrasonographic criteria for polycystic ovaries supported by the 2003 Rotterdam consensus adequately discriminate between the normal and polycystic ovary syndrome (PCOS) condition in light of recent advancements in imaging technology and reliable methods for estimating follicle populations in PCOS? STUDY ANSWER Using newer ultrasound technology and a reliable grid system approach to count follicles, we concluded that a substantially higher threshold of follicle counts throughout the entire ovary (FNPO)—26 versus 12 follicles—is required to distinguish among women with PCOS and healthy women from the general population. WHAT IS KNOWN ALREADY The Rotterdam consensus defined the polycystic ovary as having 12 or more follicles, measuring between 2 and 9 mm (FNPO), and/or an ovarian volume (OV) >10 cm3. Since their initial proposal in 2003, a heightened prevalence of polycystic ovaries has been described in healthy women with regular menstrual cycles, which has questioned the accuracy of these criteria and marginalized the specificity of polycystic ovaries as a diagnostic criterion for PCOS. STUDY DESIGN, SIZE, DURATION A diagnostic test study was performed using cross-sectional data, collected from 2006 to 2011, from 168 women prospectively evaluated by transvaginal ultrasonography. Receiver operating characteristic (ROC) curve analyses were performed to determine the appropriate diagnostic thresholds for: (i) FNPO, (ii) follicle counts in a single cross section (FNPS) and (iii) OV. The levels of intra- and inter-observer reliability when five observers used the proposed criteria on 100 ultrasound cases were also determined. PARTICIPANTS/MATERIALS, SETTING, METHODS Ninety-eight women diagnosed with PCOS by the National Institutes of Health criteria as having both oligo-amenorrhea and hyperandrogenism and 70 healthy female volunteers recruited from the general population. Participants were evaluated by transvaginal ultrasonography at the Royal University Hospital within the Department of Obstetrics, Gynecology and Reproductive Sciences, University of Saskatchewan (Saskatoon, SK, Canada) and in the Division of Nutritional Sciences' Human Metabolic Research Unit, Cornell University (Ithaca, NY, USA). MAIN RESULTS Diagnostic potential for PCOS was highest for FNPO (0.969), followed by FNPS (0.880) and OV (0.873) as judged by the area under the ROC curve. An FNPO threshold of 26 follicles had the best compromise between sensitivity (85%) and