Abstract
BackgroundThe gonadotropin-releasing hormone (GnRH) stimulation test is the benchmark for diagnosing precocious puberty (PP). However, it is invasive, time-consuming, costly, and may create an unpleasant experience for participants. Moreover, some overlaps may occur between PP and premature thelarche (PT) in the early stage of PP. Female pelvic ultrasonography may provide additional information to help differentiate PP from PT and subsequently initiate early treatment. In this study, we aimed to first directly compare pelvic ultrasonography parameters between PP and PT groups and secondly, investigate their diagnostic accuracy compared with the GnRH stimulation test.MethodsA systematic search of the PubMed/MEDLINE, EMBASE, Scopus, and Cochrane Library databases was performed up to March 31, 2021. All types of studies, except for case reports and review articles, were included. The GnRH stimulation test was used to confirm PP diagnosis. Those whose organic conditions might cause PP were excluded. The mean, standard deviation, sensitivity, and specificity of each parameter were documented. Forest plots were constructed to display the estimated standardized mean differences (SMDs) from each included study and the overall calculations. A bivariate model was used to calculate the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR).ResultsA total of 13 studies were included for analysis. The SMDs (95% confidence interval – CI) in ovarian volume, fundal-cervical ratio, uterine length, uterine cross-sectional area, and uterine volume between PP and PT groups were 1.12 (0.78–1.45; p < 0.01), 0.90 (0.07–1.73; p = 0.03), 1.38 (0.99–1.78; p < 0.01), 1.06 (0.61–1.50; p < 0.01), and 1.21 (0.84–1.58; p <0.01), respectively. A uterine length of 3.20 cm yielded a pooled sensitivity of 81.8% (95% CI 78.3%–84.9%), specificity of 82.0% (95% CI 61.0%–93.0%), PLR of 4.56 (95% CI 2.15–9.69), NLR of 0.26 (95% CI 0.17–0.39), and DOR of 19.62 (95% CI 6.45–59.68). The area under the summary receiver operating characteristics curve was 0.82.ConclusionFemale pelvic ultrasonography may serve as a complementary tool to the GnRH stimulation test in differentiating PP from PT.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021232427, ID: CRD42021232427.
Highlights
Untreated precocious puberty (PP) may result in numerous adverse outcomes [1,2,3,4,5,6]
Our findings reveal the potential application of several ultrasonography parameters other than uterine length
Uterine length represented a reliable marker to differentiate PP from premature thelarche (PT), thereby reducing the possibility of misdiagnosing PP. Pelvic ultrasonography emphasizing these measurements should be considered as an adjunct to clinical examination, bone radiography, and laboratory tests to enhance diagnostic precision
Summary
Untreated precocious puberty (PP) may result in numerous adverse outcomes [1,2,3,4,5,6]. Correct identification and early initiation of appropriate treatment for PP using gonadotropinreleasing hormone (GnRH) analogs in cases of central PP might limit these adverse outcomes. Hormonal testing (i.e., the GnRH stimulation test) is often necessary for detecting hypothalamic-pituitary-gonadal (HPG) axis activation, which is a reliable indicator of puberty Despite that, it is an invasive, time-consuming, and costly technique that may create an unpleasant experience for participants. It is an invasive, time-consuming, and costly technique that may create an unpleasant experience for participants Another major disadvantage of this test is its relatively low sensitivity despite its high specificity; this is primarily attributed to the inadequate luteinizing hormone (LH)-response to the GnRH in the initial stage of premature sexual development [7]. The gonadotropin-releasing hormone (GnRH) stimulation test is the benchmark for diagnosing precocious puberty (PP) It is invasive, timeconsuming, costly, and may create an unpleasant experience for participants. We aimed to first directly compare pelvic ultrasonography parameters between PP and PT groups and secondly, investigate their diagnostic accuracy compared with the GnRH stimulation test
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