scholarly journals Digital Rectal Examination and Balloon Expulsion Test in the Study of Defecatory Disorders: Are They Suitable as Screening or Excluding Tests?

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Ana C. Caetano ◽  
André Santa-Cruz ◽  
Carla Rolanda
Keyword(s):  
Sensitivity And Specificity ◽  
Low Cost ◽  
Random Effect ◽  
Digital Rectal Examination ◽  
Standard Test ◽  
Rectal Examination ◽  
Balloon Expulsion ◽  
Balloon Expulsion Test ◽  
Physiological Tests ◽  
Sensitivity Specificity

Background. Rome III criteria add physiological criteria to symptom-based criteria of chronic constipation (CC) for the diagnosis of defecatory disorders (DD). However, a gold-standard test is still lacking and physiological examination is expensive and time-consuming. Aim. Evaluate the usefulness of two low-cost tests—digital rectal examination (DRE) and balloon expulsion test (BET)—as screening or excluding tests of DD. Methods. We performed a systematic search in PUBMED and MEDLINE. We selected studies where constipated patients were evaluated by DRE or BET. Heterogeneity was assessed and random effect models were used to calculate the sensitivity, specificity, and negative predictive value (NPV) of the DRE and the BET. Results. Thirteen studies evaluating BET and four studies evaluating DRE (2329 patients) were selected. High heterogeneity (I2>80%) among studies was demonstrated. The studies evaluating the BET showed a sensitivity and specificity of 67% and 80%, respectively. Regarding the DRE, a sensitivity of 80% and specificity of 84% were calculated. NPV of 72% for the BET and NPV of 64% for the DRE were estimated. The sensitivity and specificity were similar when we restrict the analysis to studies using Rome criteria to define CC. The BET seems to perform better when a cut-off time of 2 minutes is used and when it is compared with a combination of physiological tests. Considering the DRE, strict criteria seem to improve the sensitivity but not the specificity of the test. Conclusion. Neither of the low-cost tests seems suitable for screening or excluding DD.

scholarly journals Does Sequential Balloon Expulsion Test improve the screening of Defecation Disorders?

2020 ◽  
Author(s):  
Ana Célia Caetano ◽  
Dalila Costa ◽  
Raquel Gonçalves ◽  
Jorge Correia-Pinto ◽  
Carla Rolanda
Keyword(s):  
Predictive Value ◽  
Low Cost ◽  
Digital Rectal Examination ◽  
Tertiary Hospital ◽  
Screening Methods ◽  
Balloon Expulsion ◽  
Defecation Disorders ◽  
Physiological Evaluation ◽  
Balloon Expulsion Test ◽  
Physiological Tests

Abstract Purpose A Defecation Disorder (DD) is a difficulty in evacuation documented by physiological exams. However, this physiological evaluation can be cumbersome, inaccessible and costly. Three “low-cost” tools to evaluate DD – a clinical DD score, the balloon expulsion test (BET) and a digital rectal examination (DRE) score were evaluated as separate or combined tests for DD screening. Methods This prospective study occurred between January 2015 and March 2019 in the Gastroenterology Department of a tertiary hospital. Besides the gold standard physiological tests, constipated patients answered the clinical DD score and were evaluated by DRE and BET (standard and variable volume (vv)). Results From 98 constipated patients, 35 (38.9%) were diagnosed with DD according to Rome IV criteria, mainly female (n = 30, 86%) with a median age of 60 years old. The clinical DD score revealed an AUC of 0.417 (SE = 0.07, p = 0.191). The DRE score displayed an AUC of 0.56 (SE = 0.063, p = 0.301). The standard BET displayed a sensitivity of 86%, specificity of 58%, positive predictive value (PPV) of 57% and negative predictive value (NPV) of 86%. The sequential vvBET followed by standard BET improved the BET performance regarding the evaluation of DD, with a sensitivity of 86%, specificity of 67%, PPV of 63% and NPV of 87%. The sequential BET had an OR 8.942, p > 0.001, CI 3.18–25.14, revealing to be the most significant predictor for DD screening. Conclusion The sequential BET is a low cost, well-performing DD screening tool, appropriate to the Primary Care Setting.

scholarly journals Does sequential balloon expulsion test improve the screening of defecation disorders?

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
A. C. Caetano ◽  
D. Costa ◽  
R. Gonçalves ◽  
J. Correia-Pinto ◽  
C. Rolanda
Keyword(s):  
Predictive Value ◽  
Low Cost ◽  
Digital Rectal Examination ◽  
Tertiary Hospital ◽  
Balloon Expulsion ◽  
Defecation Disorders ◽  
Physiological Evaluation ◽  
Balloon Expulsion Test ◽  
Physiological Tests ◽  
Defecation Disorder

Abstract Background A defecation disorder (DD) is a difficulty in evacuation documented by physiological exams. However, this physiological evaluation can be cumbersome, inaccessible and costly. Three “low-cost” tools to evaluate DD—a clinical DD score, the balloon expulsion test (BET) and a digital rectal examination (DRE) score were evaluated as separate or combined tests for DD screening. Methods This prospective study occurred between January 2015 and March 2019 in the Gastroenterology Department of a tertiary hospital. Besides the gold standard physiological tests, constipated patients answered the clinical DD score and were evaluated by DRE and BET [standard and variable volume (VV)]. Results From 98 constipated patients, 35 (38.9%) were diagnosed with DD according to Rome IV criteria, mainly female (n = 30, 86%) with a median age of 60 years old. The clinical DD score revealed an AUC of 0.417 (SE = 0.07, p = 0.191). The DRE score displayed an AUC of 0.56 (SE = 0.063, p = 0.301). The standard BET displayed a sensitivity of 86%, specificity of 58%, positive predictive value (PPV) of 57% and negative predictive value (NPV) of 86%. The sequential VVBET followed by standard BET improved the BET performance regarding the evaluation of DD, with a sensitivity of 86%, specificity of 67%, PPV of 63% and NPV of 87%. The sequential BET had an OR 8.942, p > 0.001, CI 3.18–25.14, revealing to be the most significant predictor for DD screening. Conclusion The sequential BET is a low cost, well-performing DD screening tool, appropriate to the Primary Care Setting.

scholarly journals Clinical diagnosis of prostate cancer using digital rectal examination and prostate-specific antigen tests: a systematic review and meta-analysis of sensitivity and specificity

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Nelson C. Okpua ◽  
Simon I. Okekpa ◽  
Stanley Njaka ◽  
Augusta N. Emeh
Keyword(s):  
Prostate Cancer ◽  
Prostate Specific Antigen ◽  
Sensitivity And Specificity ◽  
Specific Antigen ◽  
Digital Rectal Examination ◽  
Antigen Test ◽  
Rectal Examination ◽  
Prostate Specific Antigen Test ◽  
Prostate Cancers ◽  
Antigen Tests

Abstract Background Being diagnosed with cancer, irrespective of type initiates a serious psychological concern. The increasing rate of detection of indolent prostate cancers is a source of worry to public health. Digital rectal examination and prostate-specific antigen tests are the commonly used prostate cancer screening tests. Understanding the diagnostic accuracies of these tests may provide clearer pictures of their characteristics and values in prostate cancer diagnosis. This review compared the sensitivities and specificities of digital rectal examination and prostate-specific antigen test in detection of clinically important prostate cancers using studies from wider population. Main body We conducted literature search in PubMed, Medline, Science Direct, Wiley Online, CINAHL, Scopus, AJOL and Google Scholar, using key words and Boolean operators. Studies comparing the sensitivity and specificity of digital rectal examination and prostate-specific antigen tests in men 40 years and above, using biopsy as reference standard were retrieved. Data were extracted and analysed using Review manager (RevMan 5.3) statistical software. The overall quality of the studies was good, and heterogeneity was observed across the studies. The result comparatively shows that prostate-specific antigen test has higher sensitivity (P < 0.00001, RR 0.74, CI 0.67–0.83) and specificity (P < 0.00001, RR 1.81, CI 1.54–2.12) in the detection of prostate cancers than digital rectal examination. Conclusion Prostate-specific antigen test has higher sensitivity and specificity in detecting prostate cancers from men of multiple ethnic origins. However, combination of prostate-specific antigen test and standardized digital rectal examination procedure, along with patients history, may improve the accuracy and minimize over-diagnoses of indolent prostate cancers.

scholarly journals Clinical utility of microRNA-451 as diagnostic biomarker for human cancers

2019 ◽  
Vol 39 (1) ◽  
Author(s):  
Zhanzhan Li ◽  
Yanyan Li ◽  
Jun Fu ◽  
Na Li ◽  
Liangfang Shen
Keyword(s):  
Likelihood Ratio ◽  
Sensitivity And Specificity ◽  
Odds Ratio ◽  
Random Effect ◽  
Random Effect Model ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Diagnostic Odds Ratio ◽  
Diagnostic Ability ◽  
Sensitivity Specificity

AbstractWe conducted comprehensive analyses to assess the diagnostic ability of miRNA-451 in cancers. A systematic online search was conducted in PubMed, Web of Science, China’s national knowledge infrastructure, and VIP databases from inception to July 31, 2017. The bivariate random effect model was used for calculating sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under cure (AUC). The whole pooled sensitivity and specificity were 0.85 (0.77–0.90) and 0.85 (0.78–0.90) with their 95% confidence interval (95%CI), respectively. The pooled AUC was 0.91 (95%CI: 0.89–0.94). Positive likelihood ratio was 5.57 (95%CI: 3.74–8.31), negative likelihood ratio was 0.18 (95%CI: 0.11–0.28), and diagnostic odds ratio was 31.33 (95%CI: 15.19–64.61). Among Asian population, the sensitivity and specificity were 0.85 (95%CI: 0.77–0.91) and 0.86 (95%CI: 0.78–0.91), respectively. The positive likelihood ratio and negative likelihood ratio were 5.87 (95%CI: 3.78–9.12) and 0.17 (95%CI: 0.11–0.28). The diagnostic odds ratio and AUC were 34.31 (15.51–75.91) and 0.92 (0.89–0.94). The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and AUC for digestive system cancer were 0.83, 0.88, 6.87, 0.20, 35.13, and 0.92, respectively. The other cancers were 0.87, 0.81, 4.55, 0.16, 28.51, and 0.90, respectively. For sample source, the results still remain consistent. Our results indicated miRNA-451 has a moderate diagnostic ability for cancers, and could be a potential early screening biomarker, and considered as an adjuvant diagnostic index when being combined with other clinical examinations.

scholarly journals Digital Rectal Examination Is a Valuable Bedside Tool for Detecting Dyssynergic Defecation: A Diagnostic Study and a Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Jie Liu ◽  
Chaolan Lv ◽  
Yizhou Huang ◽  
Ying Wang ◽  
Dandan Wu ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Diagnostic Yield ◽  
Meta Analysis ◽  
Digital Rectal Examination ◽  
Functional Constipation ◽  
Cochrane Library ◽  
Diagnostic Study ◽  
Dyssynergic Defecation ◽  
Rectal Examination ◽  
Physiological Tests

Background. Accurate dyssynergic defecation (DD) diagnosis depends on anorectal physiological tests that are not widely available. Aim. The purpose of this study is to evaluate the diagnostic yield of digital rectal examination (DRE) compared with anorectal physiological tests in diagnosing DD in patients with constipation. Methods. A total of 218 chronic constipation patients who fulfilled the Rome IV diagnostic criteria for functional constipation (FC) and underwent a standardized DRE and high-resolution anorectal manometry (HRAM) test were enrolled in this study. The diagnostic accuracy of DRE compared with HRAM was evaluated, and the agreement between DRE and HRAM was calculated. Furthermore, a comprehensive literature search on PubMed, Web of Science, Cochrane Library, and Embase database was conducted to further elucidate the pooled diagnostic accuracy of DRE in DD patients. Results. A total of 101 patients (46.33%) had a DD pattern using HRAM, while 117 patients (53.67%) were diagnosed without DD. The sensitivity of DRE in diagnosing dyssynergia was 71.3%, and the specificity was 76.1%. There was a moderate agreement between DRE and HRAM for diagnosing DD (κ-coefficient = 0.474, P < 0.001 ). Meanwhile, six studies (including our study) comprising 964 constipated patients were included in our meta-analysis. The outcomes demonstrated that the AUC was 0.85 (95% CI 0.82–0.88) with 77% summary sensitivity (95% CI 65–86) and 80% summary specificity (95% CI 71–86) to diagnose DD. Conclusions. DRE could be a valuable tool for screening DD. Our study revealed acceptable sensitivity and specificity of DRE in detecting dyssynergia compared with the physiological tests. Meanwhile, our study highlights that DRE remains an important tool in clinical practice.

Echo-guided transperineal prostatic biopsy vs transrectal prostatic biopsy in the diagnosis of prostatic cancer. Our experience

1996 ◽  
Vol 63 (1_suppl) ◽  
pp. 28-31
Author(s):  
A. Valtorta ◽  
U. Mascini ◽  
G. Strada ◽  
L Carmignani
Keyword(s):  
Prostatic Cancer ◽  
Digital Rectal Examination ◽  
Transrectal Ultrasonography ◽  
Prostatic Biopsy ◽  
Rectal Examination ◽  
Transrectal Biopsy ◽  
Guided Biopsy ◽  
Reliability Sensitivity ◽  
Sensitivity Specificity ◽  
Made In

From January 1992 to May 1996, we performed 526 prostatic biopsies for suspected carcinoma after digital rectal examination (DRE), transrectal ultrasonography (TRUS) and PSA. 288 patients underwent transperineal echo-guided biopsy (TP) and 238 transrectal biopsy (TR). Diagnosis of prostatic cancer was made in 133 cases: 69 in the TP group and 64 in the TR group. We evaluated the reliability, sensitivity, specificity and complications of the two methods. TR biopsy is simple to do and well-tolerated by the patient, but has a greater number of complications.

scholarly journals Utility of digital rectal examination in a population with prostate cancer treated with active surveillance

2020 ◽  
Vol 14 (9) ◽  
Author(s):  
Jaime O. Herrera-Caceres ◽  
Marian S. Wettstein ◽  
Hanan Goldberg ◽  
Ants Toi ◽  
Thenappan Chandrasekar ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Descriptive Analysis ◽  
Digital Rectal Examination ◽  
Predictive Values ◽  
Rectal Examination ◽  
Academic Center ◽  
Multivariable Regression ◽  
Clinically Significant ◽  
Sensitivity Specificity

Introduction: Digital rectal examination (DRE) is part of the clinical evaluation of men on active surveillance (AS). The purpose of the present study is to analyze the value of DRE as a predictor of upgrading in a population of men with prostate cancer (PC) treated with AS. Methods: We used the prostate biopsy (PBx) database from an academic center, including PBx from 2006–2018, and identified 2029 confirmatory biopsies (CxPBx) of men treated with AS, of which 726 men had both diagnostic (initial) and CxPBx information available. We did a descriptive analysis and evaluated sensitivity, specificity, and predictive values of DRE for the detection of clinically significant PC (csPC). Multivariable regression analysis was done to identify predictors of csPC. The primary outcome was to evaluate DRE as a predictor of the presence of csPC at CxPBx. Results: Among the 2029 patients with a CxPBx, 75% had PC, and of these, 30.3% had upgrading to ISUP Grade ≥2. Thirteen percent of men had a suspicious DRE (done by their treating physician). Sensitivity, specificity, negative and positive predictive values of DRE to detect csPC were best with a PSA <4 ng/ml (27%, 88%, 31%, and 87%, respectively). A suspicious DRE at CxPBx, particularly if the DRE at diagnosis was negative, was a predictor of csPC (odds ratio [OR] 2.34; p=0.038). The main limitation of our study is the retrospective design and the lack of magnetic resonance imaging. Conclusions: We believe DRE should still be used as part of AS and can predict the presence of csPC even with low PSA values. A suspicious nodule on DRE represents a higher risk of upgrading and should prompt further assessment.

A Brief Measure of High Nicotine Dependence for Busy Clinicians and Large Epidemiological Surveys

2005 ◽  
Vol 39 (3) ◽  
pp. 161-168 ◽  
Author(s):  
Francisco J. Diaz ◽  
Mireia Jané ◽  
Esteve Saltó ◽  
Hélios Pardell ◽  
Lluís Salleras ◽  
...  
Keyword(s):  
Receiver Operating Characteristic ◽  
Nicotine Dependence ◽  
Sensitivity And Specificity ◽  
Operating Characteristic ◽  
Psychiatric Patients ◽  
Standard Test ◽  
Heavy Smoking ◽  
Epidemiological Surveys ◽  
Sensitivity Specificity ◽  
Receiver Operating

Objective: It is important to perform a routine screening of nicotine dependence in psychiatric patients. The Fagerström Test for Nicotine Dependence (FTND) is a widely used six-item questionnaire. The Heavy Smoking Index (HSI) is a briefer measure including only two FTND items (time to first cigarette of day and number of daily cigarettes). In a prior study comparing HSI with FTND, a high HSI (score ≥ 4) was a good and briefer alternative for detecting high nicotine dependence. The goals of this study were: (i) to compare the effectiveness of the HSI with the effectiveness of Items 1 and 4 alone for the screening of high nicotine dependence; (ii) to investigate the optimality of 4 as a cut-off score for the HSI so that the HSI can be used as a binary indicator of high nicotine dependence; and (iii) to compare the sensitivity and specificity of four indexes of high nicotine dependence, namely ‘High HSI’, ‘Very Early Smoking’, ‘Heavy Smoking’ and ‘High in Either Item’. Method: The FTND was administered to 819 current daily smokers from a general population survey. As in a prior study, an FTND score ≥ 6 was considered the reference or ‘gold standard’ test for detecting high nicotine dependence. Receiver-operating characteristic analyses were performed. Results: This new study using more sophisticated statistical methodology verified that a cut-off of 4 for the HSI is appropriate and that the ‘high’ HSI has good sensitivity and specificity even across different population subclassifications. Conclusions: With four questions (smoking, daily smoking, time to first cigarette of day and number of daily cigarettes) and minimal calculations, it may be possible to screen whether a smoker has high nicotine dependence. If other studies in other populations and settings verify this finding, this brief measure might be an ideal screening instrument for busy clinicians, epidemiologists developing questionnaires for health surveys and psychiatric researchers. Key words: nicotine dependence, receiver-operating characteristic analyses, sensitivity, specificity, tobacco smoking.

Sign in / Sign up

Export Citation Format

Share Document