Diagnostic accuracy systematic review of rectal bleeding in combination with other symptoms, signs and tests in relation to colorectal cancer

被引:33
作者
Bekkink, M. Olde [1 ,2 ]
McCowan, C. [3 ]
Falk, G. A. [1 ]
Teljeur, C. [4 ]
Van de Laar, F. A. [2 ]
Fahey, T. [1 ,3 ]
机构
[1] Royal Coll Surgeons Ireland, Dept Gen Practice, Sch Med, Dublin 2, Ireland
[2] Radboud Univ Nijmegen, Med Ctr, Dept Primary & Community Care, NL-6500 HB Nijmegen, Netherlands
[3] Univ Dundee, Hlth Informat Ctr, Div Clin & Populat Sci & Educ, Dundee DD2 4BF, Scotland
[4] AMiNCH, Trinity Ctr Hlth Sci, Dept Publ Hlth & Primary Care, Trinity Coll Dublin, Dublin 24, Ireland
关键词
rectal bleeding; diagnosis; colorectal cancer; primary care; CLINICAL-PREDICTION RULES; CONTRAST BARIUM ENEMA; PRIMARY-CARE; GENERAL-PRACTICE; FAMILY-HISTORY; POPULATION; RISK; METAANALYSIS; COLONOSCOPY; PREVALENCE;
D O I
10.1038/sj.bjc.6605426
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
BACKGROUND: Rectal bleeding is a recognised early symptom of colorectal cancer. This study aimed to assess the diagnostic accuracy of symptoms, signs and diagnostic tests in patients with rectal bleeding in relation to risk of colorectal cancer in primary care. METHODS: Diagnostic accuracy systematic review. Medline (1966 to May 2009), Embase (1988 to May 2009), British Nursing Index (1991 to May 2009) and PsychINFO (1970 to May 2009) were searched. We included cohort studies that assessed the diagnostic utility of rectal bleeding in combination with other symptoms, signs and diagnostic tests in primary care. An eight-point quality assessment tool was produced to assess the quality of included studies. Pooled positive likelihood ratios (PLRs), sensitivities and specificities were calculated. RESULTS: Eight studies incorporating 2323 patients were included. Average weighted prior probability of colorectal cancer was 7.0% (range: 3.3-15.4%, median: 8.1%). Age >= 60 years (pooled PLR: 2.79, 95% confidence interval (CI) 2.00-3.90), weight loss (pooled PLR: 1.89, 95% CI: 1.03-3.07) and change in bowel habit (pooled PLR: 1.92, 95% CI: 0.54-3.57) raise the probability of colorectal cancer into the range of referral to secondary care but do not conclusively 'rule in' the diagnosis. Presence of severe anaemia has the highest diagnostic value (pooled PLR: 3.67, 95% CI: 1.30-10.35), specificity 0.95 (95% CI: 0.93-0.96), but still only generates a posttest probability of 21.6%. CONCLUSIONS: In patients with rectal bleeding who present to their general practitioner, additional 'red flag' symptoms have modest diagnostic value. These findings have implications in relation to recommendations contained in clinical practice guidelines. British Journal of Cancer (2010) 102, 48-58. doi:10.1038/sj.bjc.6605426 www.bjcancer.com Published online 24 November 2009 (C) 2010 Cancer Research UK
引用
收藏
页码:48 / 58
页数:11
相关论文
共 48 条
[1]   Pathways to the diagnosis of colorectal cancer: an observational study in three UK cities [J].
Barrett, J ;
Jiwa, M ;
Rose, P ;
Hamilton, W .
FAMILY PRACTICE, 2006, 23 (01) :15-19
[2]  
BONELLI L, 1988, INT J CANCER, V41, P513
[3]  
Bossuyt PM, 2003, CROAT MED J, V44, P635
[4]  
Chaplin A, 2000, BRIT J GEN PRACT, V50, P798
[5]   RECTAL BLEEDING - PREVALENCE AND CONSULTATION BEHAVIOR [J].
CROSLAND, A ;
JONES, R .
BRITISH MEDICAL JOURNAL, 1995, 311 (7003) :486-488
[6]   Systematic reviews in health care - Systematic reviews of evaluations of diagnostic and screening [J].
Deeks, JJ .
BRITISH MEDICAL JOURNAL, 2001, 323 (7305) :157-162
[7]   METAANALYSIS IN CLINICAL-TRIALS [J].
DERSIMONIAN, R ;
LAIRD, N .
CONTROLLED CLINICAL TRIALS, 1986, 7 (03) :177-188
[8]   Does isolated rectal bleeding suggest colorectal cancer? [J].
Douek, M ;
Wickramasinghe, M ;
Clifton, MA .
LANCET, 1999, 354 (9176) :393-393
[9]   Risk in primary care of colorectal cancer from new onset rectal bleeding: 10 year prospective study [J].
du Toit, Jennifer ;
Hamilton, William ;
Barraclough, Kevin .
BMJ-BRITISH MEDICAL JOURNAL, 2006, 333 (7558) :69-70
[10]  
Ellis BG, 2005, BRIT J GEN PRACT, V55, P949