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Title: Optimising the investigation of haematuria and bladder cancer
Author: Tan, Wei Shen
ISNI:       0000 0004 7964 9143
Awarding Body: University College London
Current Institution: University College London (University of London)
Date of Award: 2019
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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.
Supervisor: Kelly, J. Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available