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Optimising the investigation of haematuria and bladder cancer

Tan, Wei Shen; (2019) Optimising the investigation of haematuria and bladder cancer. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

There remains a lack of consensus between guidelines on which haematuria patients should be investigated. In this doctoral thesis, I report the contemporary incidence of urinary tract cancer in haematuria patients recruited to a multi-centre study. I showed that the current National Institute for Health and Care Excellence (NICE) guidelines would miss 3.7% of cancers and that NVH warrants investigation due to the risk of high risk bladder cancer. I subsequently reported that ultrasound can safely replace CT urogram for the imaging of the upper urinary tracts in NVH patients despite a low sensitivity of upper tract urothelial cancer (UTUC) because of a very low (0%) incidence of UTUC. Analysis of urine cytology suggests that it has a poor sensitivity for the detection of bladder cancer and UTUC and a high risk of false positive result. My systematic review of urine-based biomarkers for the detection of bladder cancer indicates that multi-target panels have a better diagnostic performance although no biomarker has been prospectively validated in a clinical trial. An interim analysis of the diagnostic performance of the UroMark assay in a prospective study report a sensitivity of 87.5% with a negative predictive value of 92.9%. I subsequently developed and validated a nomogram to guide patient selection for haematuria investigation. The haematuria cancer risk score (HCRS) approach identified more urinary tract cancers compared to the current NICE guidance. Finally, I utilised a mixed method approach and reported that >75% of patients would accept a urine-based biomarker with a minimum sensitivity of 90% in the non-muscle invasive bladder cancer surveillance setting. Direct visualisation of bladder cancer is a key feature of cystoscopy which patients hold in high regard. In conclusion, these findings are important and will assist the development of future haematuria guidelines both in terms of patient selection and choice of diagnostic tests. It also offers guidance to other research groups in biomarker discovery who are planning future biomarker validation studies.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: Optimising the investigation of haematuria and bladder cancer
Event: Univetrsity College London
Language: English
Additional information: Copyright © The Author 2019. Original content in this thesis is licensed under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) Licence (https://creativecommons.org/licenses/by/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request.
Keywords: bladder cancer, haematuria, diagnostic, imaging, biomarker, urine, clinical trail, kidney cancer
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Targeted Intervention
URI: https://discovery.ucl.ac.uk/id/eprint/10070614
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