Maclean William, Benton Sally C, Whyte Martin B, Rockall Timothy, Jourdan Iain
Colorectal Surgery, Royal Surrey NHS Foundation Trust, Guildford, UK.
Bowel Cancer Screening Hub at Royal Surrey NHS Foundation Trust, Guildford, UK.
Ann Clin Biochem. 2023 May;60(3):169-176. doi: 10.1177/00045632231155021. Epub 2023 Mar 9.
A digital rectal examination (DRE) during routine assessment for patients with abdominal symptoms provides an opportunity to obtain faeces from the glove for faecal immunochemical testing (FIT). Here, we compared sampling via DRE to the standard faecal sampling by patients.
Patients were recruited to a prospective observational cohort study between July 2019 and March 2020. Patients provided a sample for the FOB Gold Wide which was compared to a further sample taken at clinic via DRE. Clinicians reported whether they obtained a 'good' sample filling all the grooves, a 'poor' sample filling some of the grooves or no faecal sample. Cohen's kappa was used to compare percentage agreement around a negative threshold of <10 μg haemoglobin/g of faeces. Sensitivity for serious bowel disease (SBD) was calculated.
Of 596 patients who underwent attempted DRE sampling, there were 258 (43.3%) 'good' samples, 117 (19.6%) 'poor' samples and 221 (37.1%) with no sample to wipe in the grooves. Cohen's kappa dropped from 0.70 to 0.30 for the 'good' and 'poor' samples, respectively. Of those with DRE samples and definitive diagnostic outcomes, the sensitivity for SBD dropped significantly from 76.0% to 41.7% between 'good' and 'poor' samples, respectively ( = 0.041).
A 'good' sample obtained by DRE provides comparable results to samples obtained by patients. This creates potential benefit in speed and ease of testing for patients. However, not all DRE sampling attempts are successful, and the clinician must be satisfied that enough faeces is obtained to wipe adequately into all grooves.
在对有腹部症状的患者进行常规评估时，直肠指检（DRE）可为从手套上获取粪便进行粪便免疫化学检测（FIT）提供机会。在此，我们将通过DRE采样与患者的标准粪便采样进行了比较。
在2019年7月至2020年3月期间招募患者进行一项前瞻性观察队列研究。患者提供一份用于粪便潜血金标试纸（FOB Gold Wide）检测的样本，并将其与在诊所通过DRE采集的另一份样本进行比较。临床医生报告他们是否获得了一个“良好”样本（填满所有凹槽）、一个“不佳”样本（填满部分凹槽）或未获得粪便样本。使用Cohen's kappa系数比较粪便血红蛋白含量<10μg/g这一阴性阈值周围的百分比一致性。计算严重肠道疾病（SBD）的敏感度。
在596例尝试进行DRE采样的患者中，有258例（43.3%）获得“良好”样本，117例（19.6%）获得“不佳”样本，221例（37.1%）的凹槽中没有可擦拭的样本。“良好”和“不佳”样本的Cohen's kappa系数分别从0.70降至0.30。在有DRE样本且有明确诊断结果的患者中，“良好”和“不佳”样本对SBD的敏感度分别从76.0%显著降至41.7%（P = 0.041）。
通过DRE获得的“良好”样本与患者获得的样本结果相当。这在检测速度和便捷性方面为患者带来了潜在益处。然而，并非所有DRE采样尝试都能成功，临床医生必须确保获得足够的粪便以充分擦拭到所有凹槽中。
