Diagnostic accuracy systematic review of rectal bleeding in combination with other symptoms, signs and tests in relation to colorectal cancer
Autor: | Gavin A. Falk, Colin McCowan, F.A. van de Laar, M Olde Bekkink, Conor Teljeur, Tom Fahey |
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Jazyk: | angličtina |
Rok vydání: | 2009 |
Předmět: |
Male
Cancer Research Colorectal cancer diagnosis Colonoscopy Gastroenterology Cohort Studies RA0421 Clinical Studies Prospective Studies Prospective cohort study rectal bleeding Sigmoidoscopy Ultrasonography education.field_of_study medicine.diagnostic_test Anemia Middle Aged Reference Standards Oncology Female Colorectal Neoplasms Family Practice Gastrointestinal Hemorrhage Cohort study Adult Risk medicine.medical_specialty Population Pain colorectal cancer Enema Adenocarcinoma Sensitivity and Specificity RC0254 primary care Internal medicine Weight Loss medicine Humans education Rectal hemorrhage Aged Primary Health Care business.industry Rectum Cancer medicine.disease Radiography Barium Sulfate business |
Zdroj: | British Journal of Cancer |
ISSN: | 1532-1827 0007-0920 |
Popis: | 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.\ud 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.\ud 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 post-test probability of 21.6%.\ud 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. |
Databáze: | OpenAIRE |
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