Objective: To investigate the characteristics of the rectal potentially malignant nodules in female by digital rectal examination (DRE). Methods: Retrospectively, we collected the medical information and follow-up of rectal nodules cases diagnosed as benign by DRE during the health check-up in our hospital from Jan 2002 to Dec 2015. All nodules were recorded position, size, shape, hardness and mobility. Statistical analysis was performed to select the potentially malignant cases of postoperative pathological diagnosis and disappeared nodules followed up by DRE. Results: We followed up 190 cases with 195 nodules finally. Twenty-five cases were potentially malignant, including 14 (56.0%) of polyps, 9 (36.0%) neuroendocrine tumors, and 2 (8.0%) gastrointestinal stromal tumors. The sizes of the nodules were <1.0 cm of 23 (92%) cases, among them 12 (48%) cases were ≤0.5 cm, while 23 nodules (92%) were mobile.There were two cases of potentially malignancy in both groups with enlarged and unchanged modules.There were 69 cases of nodules disappeared during follow-up. The size of these nodules were <1.0 cm, 63(91.3%) cases ≤0.5 cm. while 32 (46.4%) were fixed. The univariate analysis showed that the detection rate of potentially malignant group was higher than that of disappeared group in age (t=-3.691, P<0.01), size (Z=-3.537, P<0.01) and mobility (χ(2)=13.315, P=0.001). On multivariate analysis, the risk of potentially malignant increased with age (OR=2.324, P=0.004) and the size (OR=1.537, P=0.003) of the nodules. The risk of fixed small nodules (OR=0.081, P=0.020) was lower than that of the mobile nodules. All the above differences were statistically significant. Conclusions: The risk of potential malignancy increased with age and the size of the nodule in female. The risk of fixed small nodules, which were regard as malignant, was lower than that of mobile nodules. Potential malignancy should exclude in small, enlarged or unchanged nodules during follow-up.
目的： 鉴别分析直肠指检中女性直肠潜在恶性结节的特点。 方法： 回顾性分析了2002年1月至2015年12月北京协和医院女性健康体检中直肠指检初诊良性并随访的直肠结节病例，对所有结节均记录位置、大小、形态、硬度及活动度，选择其中手术病理结果具有潜在恶性与直肠指检随访结节消失者进行统计学分析。 结果： 成功随访190例195个结节。手术潜在恶性25例中息肉14例(56.0%)、神经内分泌肿瘤9例(36.0%，含类癌5例)、直肠胃肠间质瘤2例(8.0%)；结节直径<1.0 cm者23例(92%)、其中≤0.5 cm者12例(48%)；结节可活动23例(92%)。随访增大和无变化结节中各检出潜在恶性2例。随访结节消失69例，直径均<1.0 cm，其中直径≤0.5 cm者63例(91.3%)，不活动结节32例(46.4%)。单因素分析显示，手术潜在恶性组的年龄(t＝－3.691，P<0.01)、结节直径(Z＝－3.537，P<0.01)均大于结节消失组，可活动结节(χ(2)＝13.315，P＝0.001)检出率高于结节消失组。多因素分析显示，潜在恶性风险随年龄(OR＝2.324，P＝0.004)和结节直径(OR＝1.537，P＝0.003)的增大而增加，不活动微小结节(OR＝0.081，P＝0.020)的风险低于可活动结节。所有差异均有统计学意义。 结论： 健康女性直肠指检中潜在恶性结节风险随年龄和结节的增大而增加；微小结节中看似具有恶性特点的不活动结节的风险低于可活动结节；粟粒样微小结节、随访结节增大或无变化者均有潜在恶性的可能。.
Keywords: Digital rectal examination (DRE); Mass screening; Precancerous conditions; Rectal neoplasms.