The diagnostic value of digital rectal examination in primary care for palpable rectal tumour.
BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Ang
C W
CW
Maryfield Walk, Penkhull, Stoke-On-Trent, UK. acwee@doctors.org.uk
Dawson
R
R
Hall
C
C
Farmer
M
M
D003113:Colonoscopy / Q000379:methods / Q000706:statistics & numerical data; D051517:Digital Rectal Examination / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D011237:Predictive Value of Tests; D011320:Primary Health Care / Q000379:methods*; D011336:Probability; D012004:Rectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012042:Registries; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D006113:United Kingdom; D014850:Waiting Lists