Ang C W, Dawson R, Hall C, Farmer M
Maryfield Walk, Penkhull, Stoke-On-Trent, UK.
Colorectal Dis. 2008 Oct;10(8):789-92. doi: 10.1111/j.1463-1318.2007.01381.x. Epub 2007 Sep 14.
Accurate digital rectal examination (DRE) enables the early diagnosis of palpable rectal tumour. We aimed at evaluating the diagnostic value of DRE performed by general practitioners (GPs), with respect to detecting the presence of a palpable rectal tumour.
All patients diagnosed to have a palpable rectal tumour via a 14-day cancer referral system between May and December 2006 were identified from the colorectal database. Patients referred by GPs during the same period as having a palpable rectal tumour were also identified by reviewing the 14-day cancer referrals. Sensitivity, specificity, positive and negative predictive value of a DRE in primary care were calculated by using these data.
Between May and December 2006, 1069 patients were referred to the University Hospital of North Staffordshire to the 14-day urgent colorectal cancer referral service. Of these, 108 patients were referred as having a 'palpable rectal tumour'. Only 32 of the 108 were found to have a rectal lesion on examination in the hospital. Ten tumours were missed by GPs' DREs.
Digital rectal examination in primary care for palpable rectal tumour has a sensitivity of 0.762, specificity of 0.917, positive predictive value of 0.296 and negative predictive value of 0.988. It is an inaccurate procedure and a poor predictor for palpable rectal tumour.
准确的直肠指检（DRE）有助于早期诊断可触及的直肠肿瘤。我们旨在评估全科医生（GP）进行的直肠指检在检测可触及直肠肿瘤方面的诊断价值。
从结直肠数据库中识别出2006年5月至12月期间通过14天癌症转诊系统被诊断为可触及直肠肿瘤的所有患者。通过回顾14天癌症转诊记录，还识别出同期由全科医生转诊为可触及直肠肿瘤的患者。利用这些数据计算初级保健中直肠指检的敏感性、特异性、阳性预测值和阴性预测值。
2006年5月至12月期间，1069名患者被转诊至北斯塔福德郡大学医院的14天紧急结直肠癌转诊服务。其中，108名患者被转诊为“可触及直肠肿瘤”。在医院检查中，108名患者中只有32名被发现有直肠病变。全科医生的直肠指检漏诊了10个肿瘤。
初级保健中对可触及直肠肿瘤进行的直肠指检，敏感性为0.762，特异性为0.917，阳性预测值为0.296，阴性预测值为0.988。这是一种不准确的检查方法，对可触及直肠肿瘤的预测效果不佳。
