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Is a Hemoccult-positive rectal examination clinically significant?
S L Brint1, J A DiPalma, J L Herrera
1Division of Gastroenterology, University of South Alabama College of Medicine, Mobile 36617.
Insights
Digital rectal exam occult blood testing in asymptomatic patients can detect significant neoplastic lesions, including adenocarcinomas and polyps. Positive results warrant colonoscopy for early cancer detection in at-risk individuals.
Area of Science:
- Gastroenterology
- Oncology
- Diagnostic Medicine
Background:
- Digital rectal examination (DRE) is a common procedure.
- Occult blood testing during DRE may indicate gastrointestinal pathology.
- Clinical significance in asymptomatic patients requires clarification.
Purpose of the Study:
- To evaluate the clinical significance of occult blood detection during DRE in patients without gastrointestinal complaints.
- To determine the yield of colonoscopy following a positive Hemoccult test during DRE in this population.
Main Methods:
- Retrospective review of 185 patients undergoing colonoscopy after a positive Hemoccult test during DRE.
- Analysis of patient demographics, colonoscopy findings (neoplastic vs. nonneoplastic lesions), and associated clinical factors.
- Comparison of characteristics between patients with and without neoplastic findings.
Main Results:
- Neoplastic lesions (13 adenocarcinomas, 38 adenomatous polyps) were identified in 28% of patients (51/185).
- Colonoscopies were normal in 41% (75/185) and revealed nonneoplastic lesions in 32%.
- No neoplastic lesions were found in patients under 45 years old.
Conclusions:
- Occult blood testing during DRE in asymptomatic individuals does not increase false positives.
- A positive test should prompt colonoscopy for neoplasia detection, especially in patients with age-related risk factors for colon cancer.
- The procedure is valuable for identifying significant gastrointestinal pathology in asymptomatic patients.
Abstract:
To determine the clinical significance of finding occult blood in a stool sample obtained during digital rectal examination of patients with no gastrointestinal complaints, we reviewed the records of patients who had colonoscopy for this indication. Of the 185 patients (average age, 59.4 years) who met study criteria, 48 were inpatients when the Hemoccult-positive rectal examination was recorded. Neoplastic lesions were found in 28% of the patients (51/185). Thirteen of the lesions were adenocarcinomas and 38 were adenomatous polyps. Seventy-five patients (41%) had normal findings on colonoscopy. Nonneoplastic lesions were found in the remaining 32%. Comparison of patients with neoplastic lesions and patients with nonneoplastic lesions showed no significant difference with respect to the presence of anemia (43% vs 48%), inpatient status at the time of positive rectal examination (23% vs 29%), or sex. Although the mean age was similar in patients with and without neoplastic lesions (60.5 and 56.8 years, respectively), no neoplastic lesions were found in patients less than 45 years old. We conclude that testing stool obtained during rectal examination for occult blood does not increase the rate of false-positive results, and positive test should prompt a structural evaluation of the colon to detect neoplasia in patients with an age-related risk for colon carcinoma.