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Tan WS, Ahmad A, Zhou Y, Nathan A, Ogunbo A, Gbolahan O, Kallam N, Smith R, Khalifeh M, Tan WP, Cohen D, Volanis D, Walter FM, Sasieni P, Kamat AM, Kelly JD. Hematuria Cancer Risk Score with Ultrasound Informs Cystoscopy Use in Patients with Hematuria. Eur Urol Oncol 2024:S2588-9311(24)00134-2. [PMID: 38811250 DOI: 10.1016/j.euo.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/04/2024] [Accepted: 05/07/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Hematuria is a cardinal symptom of urinary tract cancer and would require further investigations. OBJECTIVE To determine the ability of renal bladder ultrasound (RBUS) with the Hematuria Cancer Risk Score (HCRS) to inform cystoscopy use in patients with hematuria. DESIGN, SETTING, AND PARTICIPANTS The development cohort comprised 1984 patients with hematuria from 40 UK hospitals (DETECT 1; ClinicalTrials.gov: NCT02676180) who received RBUS. An independent validation cohort comprised 500 consecutive patients referred to secondary care for a suspicion of bladder cancer. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Sensitivity and true negative of the HCRS and RBUS were assessed. RESULTS AND LIMITATIONS A total of 134 (7%) and 36 (8%) patients in the development and validation cohorts, respectively, had a diagnosis of urinary tract cancer. Validation of the HCRS achieves good discrimination with an area under the receiver operating characteristic curve of 0.727 (95% confidence interval 0.648-0.800) in the validation cohort with sensitivity of 95% for the identification of cancer. Utilizing the cutoff of 4.500 derived from the HCRS in combination with RBUS in the development cohort, 680 (34%) patients would have been spared cystoscopy at the cost of missing a G1 Ta bladder cancer and a urinary tract cancer patient, while 117 (25%) patients would have avoided cystoscopy at the cost of missing a single patient of G1 Ta bladder cancer with sensitivity for the identification of cancer of 97% in the validation cohort. CONCLUSIONS The HCRS with RBUS offers good discriminatory ability in identifying patients who would benefit from cystoscopy, sparing selected patient cohorts from an invasive procedure. PATIENT SUMMARY The hematuria cancer risk score with renal bladder ultrasound allows for the triage of patients with hematuria who would benefit from visual examination of the bladder (cystoscopy). This resulted in 25% of patients safely omitting cystoscopy, which is an invasive procedure, and would lead to health care cost savings.
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Affiliation(s)
- Wei Shen Tan
- Department of Urology, University of Texas MD Anderson Cancer Centre, Houston, TX, USA; Division of Surgery and Interventional Science, University College London, London, UK.
| | - Amar Ahmad
- Division of Surgery and Interventional Science, University College London, London, UK; Cancer Intelligence, Cancer Research UK, London, UK
| | - Yin Zhou
- Department of Public health and Primary Care, University of Cambridge, Cambridge, UK; Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Arjun Nathan
- Department of Urology, University of Texas MD Anderson Cancer Centre, Houston, TX, USA; Department of Urology, Royal Free Hospital, London, UK
| | | | | | - Neha Kallam
- Department of Urology, Royal Free Hospital, London, UK
| | - Rebecca Smith
- Department of Urology, Royal Free Hospital, London, UK
| | - Maen Khalifeh
- Department of Urology, Royal Free Hospital, London, UK
| | - Wei Phin Tan
- Department of Urology, New York University Langone Health, New York City, NY, USA
| | - Daniel Cohen
- Department of Urology, Royal Free Hospital, London, UK
| | | | - Fiona M Walter
- Department of Public health and Primary Care, University of Cambridge, Cambridge, UK; Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Peter Sasieni
- Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, Innovation Hub, Guys Cancer Centre, Guys Hospital, King's College London, London, UK
| | - Ashish M Kamat
- Division of Surgery and Interventional Science, University College London, London, UK
| | - John D Kelly
- Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospitals, London, UK
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Köhler CU, Schork K, Turewicz M, Eisenacher M, Roghmann F, Noldus J, Marcus K, Brüning T, Käfferlein HU. Use of Multiple Machine Learning Approaches for Selecting Urothelial Cancer-Specific DNA Methylation Biomarkers in Urine. Int J Mol Sci 2024; 25:738. [PMID: 38255812 PMCID: PMC10815677 DOI: 10.3390/ijms25020738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/03/2024] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
Diagnosing urothelial cancer (UCa) via invasive cystoscopy is painful, specifically in men, and can cause infection and bleeding. Because the UCa risk is higher for male patients, urinary non-invasive UCa biomarkers are highly desired to stratify men for invasive cystoscopy. We previously identified multiple DNA methylation sites in urine samples that detect UCa with a high sensitivity and specificity in men. Here, we identified the most relevant markers by employing multiple statistical approaches and machine learning (random forest, boosted trees, LASSO) using a dataset of 251 male UCa patients and 111 controls. Three CpG sites located in ALOX5, TRPS1 and an intergenic region on chromosome 16 have been concordantly selected by all approaches, and their combination in a single decision matrix for clinical use was tested based on their respective thresholds of the individual CpGs. The combination of ALOX5 and TRPS1 yielded the best overall sensitivity (61%) at a pre-set specificity of 95%. This combination exceeded both the diagnostic performance of the most sensitive bioinformatic approach and that of the best single CpG. In summary, we showed that overlap analysis of multiple statistical approaches identifies the most reliable biomarkers for UCa in a male collective. The results may assist in stratifying men for cystoscopy.
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Affiliation(s)
- Christina U. Köhler
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Ruhr University Bochum (IPA), Bürkle-de-la-Camp Platz 1, 44789 Bochum, Germany; (C.U.K.)
| | - Karin Schork
- Medizinisches Proteom-Center, Medical Faculty, Ruhr-University Bochum and Medical Proteome Analysis, Center for Protein Diagnostics (PRODI), Gesundheitscampus 4, 44081 Bochum, Germany
| | - Michael Turewicz
- Medizinisches Proteom-Center, Medical Faculty, Ruhr-University Bochum and Medical Proteome Analysis, Center for Protein Diagnostics (PRODI), Gesundheitscampus 4, 44081 Bochum, Germany
| | - Martin Eisenacher
- Medizinisches Proteom-Center, Medical Faculty, Ruhr-University Bochum and Medical Proteome Analysis, Center for Protein Diagnostics (PRODI), Gesundheitscampus 4, 44081 Bochum, Germany
| | - Florian Roghmann
- Department of Urology, Marien Hospital Herne, University Hospital of the Ruhr University Bochum, Hölkeskampring 40, 44625 Herne, Germany
| | - Joachim Noldus
- Department of Urology, Marien Hospital Herne, University Hospital of the Ruhr University Bochum, Hölkeskampring 40, 44625 Herne, Germany
| | - Katrin Marcus
- Medizinisches Proteom-Center, Medical Faculty, Ruhr-University Bochum and Medical Proteome Analysis, Center for Protein Diagnostics (PRODI), Gesundheitscampus 4, 44081 Bochum, Germany
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Ruhr University Bochum (IPA), Bürkle-de-la-Camp Platz 1, 44789 Bochum, Germany; (C.U.K.)
| | - Heiko U. Käfferlein
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Ruhr University Bochum (IPA), Bürkle-de-la-Camp Platz 1, 44789 Bochum, Germany; (C.U.K.)
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Duquesne I, Abou Chakra M, Hage L, Pinar U, Loriot Y. Liquid biopsies for detection, surveillance, and prognosis of urothelial cancer: a future standard? Expert Rev Anticancer Ther 2023; 23:995-1007. [PMID: 37542214 DOI: 10.1080/14737140.2023.2245144] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 08/02/2023] [Indexed: 08/06/2023]
Abstract
INTRODUCTION Liquid biopsies are used for the detection of tumor-specific elements in body fluid. Their application in prognosis and diagnosis of muscle/non-muscle invasive bladder cancer (MIBC/NMIBC) or upper tract urothelial cancer (UTUC) remains poorly known and rarely mentioned in clinical guidelines. AREAS COVERED Herein, we provide an overview of current data regarding the use of liquid biopsies in urothelial tumors. EXPERT OPINION Studies that were included analyzed liquid biopsies using the detection of circulating tumor cells (CTCs), deoxyribonucleic acid (DNA), ribonucleic acid (RNA), exosomes, or metabolomics. The sensitivity of blood CTC detection in patients with localized cancer was 35% and raised to 50% in patients with metastatic cancer. In NMIBC patients, blood CTC was associated with poor prognosis, whereas discrepancies were seen in MIBC patients. Circulating plasma DNA presented a superior sensitivity to urine and was a good indicator for diagnosis, follow-up, and oncological outcome. In urine, specific bladder cancer (BC) microRNA had an overall sensitivity of 85% and a specificity of 86% in the diagnosis of urothelial cancer. These results are in favor of the use of liquid biopsies as biomarkers for in urothelial cancer management.
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Affiliation(s)
- Igor Duquesne
- Department of Urology, Cochin Hospital, Assistance Publique-Hopitaux de Paris, Universite Paris Cite, Paris, France
| | - Mohamad Abou Chakra
- Department of Urology, Cochin Hospital, Assistance Publique-Hopitaux de Paris, Universite Paris Cite, Paris, France
| | - Lory Hage
- Department of Urology, Cochin Hospital, Assistance Publique-Hopitaux de Paris, Universite Paris Cite, Paris, France
| | - Ugo Pinar
- Department of Urology, Pitie Salpetriere Hospital, Assistance Publique-Hopitaux de Paris, Universite Paris Sorbonne, Paris, France
| | - Yohann Loriot
- Department of Cancer Medicine, Gustave Roussy Institute, Cancer Campus, Grand Paris, Universite Paris-Sud, Villejuif, France
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Heer R, Lewis R, Duncan A, Penegar S, Vadiveloo T, Clark E, Yu G, Mariappan P, Cresswell J, McGrath J, N'Dow J, Nabi G, Mostafid H, Kelly J, Ramsay C, Lazarowicz H, Allan A, Breckons M, Campbell K, Campbell L, Feber A, McDonald A, Norrie J, Orozco-Leal G, Rice S, Tandogdu Z, Taylor E, Wilson L, Vale L, MacLennan G, Hall E. Photodynamic versus white-light-guided resection of first-diagnosis non-muscle-invasive bladder cancer: PHOTO RCT. Health Technol Assess 2022; 26:1-144. [PMID: 36300825 PMCID: PMC9639219 DOI: 10.3310/plpu1526] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Around 7500 people are diagnosed with non-muscle-invasive bladder cancer in the UK annually. Recurrence following transurethral resection of bladder tumour is common, and the intensive monitoring schedule required after initial treatment has associated costs for patients and the NHS. In photodynamic diagnosis, before transurethral resection of bladder tumour, a photosensitiser that is preferentially absorbed by tumour cells is instilled intravesically. Transurethral resection of bladder tumour is then conducted under blue light, causing the photosensitiser to fluoresce. Photodynamic diagnosis-guided transurethral resection of bladder tumour offers better diagnostic accuracy than standard white-light-guided transurethral resection of bladder tumour, potentially reducing the chance of subsequent recurrence. OBJECTIVE The objective was to assess the clinical effectiveness and cost-effectiveness of photodynamic diagnosis-guided transurethral resection of bladder tumour. DESIGN This was a multicentre, pragmatic, open-label, parallel-group, non-masked, superiority randomised controlled trial. Allocation was by remote web-based service, using a 1 : 1 ratio and a minimisation algorithm balanced by centre and sex. SETTING The setting was 22 NHS hospitals. PARTICIPANTS Patients aged ≥ 16 years with a suspected first diagnosis of high-risk non-muscle-invasive bladder cancer, no contraindications to photodynamic diagnosis and written informed consent were eligible. INTERVENTIONS Photodynamic diagnosis-guided transurethral resection of bladder tumour and standard white-light cystoscopy transurethral resection of bladder tumour. MAIN OUTCOME MEASURES The primary clinical outcome measure was the time to recurrence from the date of randomisation to the date of pathologically proven first recurrence (or intercurrent bladder cancer death). The primary health economic outcome was the incremental cost per quality-adjusted life-year gained at 3 years. RESULTS We enrolled 538 participants from 22 UK hospitals between 11 November 2014 and 6 February 2018. Of these, 269 were allocated to photodynamic diagnosis and 269 were allocated to white light. A total of 112 participants were excluded from the analysis because of ineligibility (n = 5), lack of non-muscle-invasive bladder cancer diagnosis following transurethral resection of bladder tumour (n = 89) or early cystectomy (n = 18). In total, 209 photodynamic diagnosis and 217 white-light participants were included in the clinical end-point analysis population. All randomised participants were included in the cost-effectiveness analysis. Over a median follow-up period of 21 months for the photodynamic diagnosis group and 22 months for the white-light group, there were 86 recurrences (3-year recurrence-free survival rate 57.8%, 95% confidence interval 50.7% to 64.2%) in the photodynamic diagnosis group and 84 recurrences (3-year recurrence-free survival rate 61.6%, 95% confidence interval 54.7% to 67.8%) in the white-light group (hazard ratio 0.94, 95% confidence interval 0.69 to 1.28; p = 0.70). Adverse event frequency was low and similar in both groups [12 (5.7%) in the photodynamic diagnosis group vs. 12 (5.5%) in the white-light group]. At 3 years, the total cost was £12,881 for photodynamic diagnosis-guided transurethral resection of bladder tumour and £12,005 for white light. There was no evidence of differences in the use of health services or total cost at 3 years. At 3 years, the quality-adjusted life-years gain was 2.094 in the photodynamic diagnosis transurethral resection of bladder tumour group and 2.087 in the white light group. The probability that photodynamic diagnosis-guided transurethral resection of bladder tumour was cost-effective was never > 30% over the range of society's cost-effectiveness thresholds. LIMITATIONS Fewer patients than anticipated were correctly diagnosed with intermediate- to high-risk non-muscle-invasive bladder cancer before transurethral resection of bladder tumour and the ratio of intermediate- to high-risk non-muscle-invasive bladder cancer was higher than expected, reducing the number of observed recurrences and the statistical power. CONCLUSIONS Photodynamic diagnosis-guided transurethral resection of bladder tumour did not reduce recurrences, nor was it likely to be cost-effective compared with white light at 3 years. Photodynamic diagnosis-guided transurethral resection of bladder tumour is not supported in the management of primary intermediate- to high-risk non-muscle-invasive bladder cancer. FUTURE WORK Further work should include the modelling of appropriate surveillance schedules and exploring predictive and prognostic biomarkers. TRIAL REGISTRATION This trial is registered as ISRCTN84013636. FUNDING This project was funded by the National Institute for Health and Care Research ( NIHR ) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 40. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Rakesh Heer
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Rebecca Lewis
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Anne Duncan
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - Steven Penegar
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Thenmalar Vadiveloo
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - Emma Clark
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Ge Yu
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | | | - Joanne Cresswell
- Department of Urology, South Tees Hospitals NHS Trust, Middlesbrough, UK
| | - John McGrath
- Department of Urology, Royal Devon and Exeter Hospital NHS Trust, Exeter, UK
| | - James N'Dow
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Ghulam Nabi
- School of Medicine, University of Dundee, Dundee, UK
| | - Hugh Mostafid
- Department of Urology, Basingstoke and North Hampshire NHS Foundation Trust, Basingstoke, UK
| | - John Kelly
- University College London Cancer Institute, University College London Hospitals NHS Foundation Trust, London, UK
| | - Craig Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Henry Lazarowicz
- Department of Urology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Angela Allan
- Department of Urology, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - Matthew Breckons
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Karen Campbell
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - Louise Campbell
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - Andy Feber
- University College London Cancer Institute, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alison McDonald
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - Giovany Orozco-Leal
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Stephen Rice
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Zafer Tandogdu
- University College London Cancer Institute, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Laura Wilson
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Luke Vale
- Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Graeme MacLennan
- Centre for Healthcare Randomised Trials (CHaRT), University of Aberdeen, Aberdeen, UK
| | - Emma Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
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Malinaric R, Mantica G, Lo Monaco L, Mariano F, Leonardi R, Simonato A, Van der Merwe A, Terrone C. The Role of Novel Bladder Cancer Diagnostic and Surveillance Biomarkers-What Should a Urologist Really Know? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159648. [PMID: 35955004 PMCID: PMC9368399 DOI: 10.3390/ijerph19159648] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 07/29/2022] [Accepted: 07/31/2022] [Indexed: 05/20/2023]
Abstract
The aim of this review is to analyze and describe the current landscape of bladder cancer diagnostic and surveillance biomarkers. We researched the literature from 2016 to November 2021 to find the most promising new molecules and divided them into seven different subgroups based on their function and location in the cell. Although cystoscopy and cytology are still the gold standard for diagnosis and surveillance when it comes to bladder cancer (BCa), their cost is quite a burden for national health systems worldwide. Currently, the research is focused on finding a biomarker that has high negative predictive value (NPV) and can exclude with a certainty the presence of the tumor, considering missing it could be disastrous for the patient. Every subgroup has its own advantages and disadvantages; for example, protein biomarkers cost less than genomic ones, but on the other hand, they seem to be less precise. We tried to simplify this complicated topic as much as possible in order to make it comprehensible to doctors and urologists that are not as familiar with it, as well as encourage them to actively participate in ongoing research.
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Affiliation(s)
- Rafaela Malinaric
- Department of Urology, IRCCS Policlinic Hospital San Martino, 16132 Genoa, Italy
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), University of Genoa, 16132 Genoa, Italy
- Correspondence:
| | - Guglielmo Mantica
- Department of Urology, IRCCS Policlinic Hospital San Martino, 16132 Genoa, Italy
| | - Lorenzo Lo Monaco
- Department of Urology, IRCCS Policlinic Hospital San Martino, 16132 Genoa, Italy
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), University of Genoa, 16132 Genoa, Italy
| | - Federico Mariano
- Department of Urology, IRCCS Policlinic Hospital San Martino, 16132 Genoa, Italy
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), University of Genoa, 16132 Genoa, Italy
| | - Rosario Leonardi
- Department of Urology, Casa di Cura Musumeci GECAS, 95030 Gravina di Catania, Italy
| | - Alchiede Simonato
- Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, 90133 Palermo, Italy
| | - André Van der Merwe
- Department of Urology, Tygerberg Academic Hospital, Stellenbosch University, Cape Town 7600, South Africa
| | - Carlo Terrone
- Department of Urology, IRCCS Policlinic Hospital San Martino, 16132 Genoa, Italy
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), University of Genoa, 16132 Genoa, Italy
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Crocetto F, Barone B, Ferro M, Busetto GM, La Civita E, Buonerba C, Di Lorenzo G, Terracciano D, Schalken JA. Liquid biopsy in bladder cancer: State of the art and future perspectives. Crit Rev Oncol Hematol 2022; 170:103577. [PMID: 34999017 DOI: 10.1016/j.critrevonc.2022.103577] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/02/2022] [Accepted: 01/04/2022] [Indexed: 01/01/2023] Open
Abstract
Bladder cancer is the most common malignancy of the urinary tract. Cystoscopy represents the gold standard in the diagnosis of suspicious bladder lesions. However, the procedure is invasive and burdened by pain, discomfort and infective complications. Cytology, which represents an alternative diagnostic possibility is limited by poor sensitivity. Considering the limitations of both procedures, and the necessity to perform multiple evaluations in patients who are in follow-up for bladder cancer, an improved non-invasive methodology is required in the clinical management of this disease. Liquid biopsy, e.g. the detection of clinical biomarkers in urine, represent a promising novel and non-invasive approach that could overcome those limitations and be integrated into the current clinical practice. The aim of this review is to summarize the state of the art of this approach and the latest novelties regarding detection, prognosis and surveillance of bladder cancer.
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Affiliation(s)
- Felice Crocetto
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Biagio Barone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy.
| | - Matteo Ferro
- Department of Urology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Gian Maria Busetto
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Evelina La Civita
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Carlo Buonerba
- Oncology Unit, Hospital "Andrea Tortora", ASL Salerno, Pagani, Italy
| | - Giuseppe Di Lorenzo
- Oncology Unit, Hospital "Andrea Tortora", ASL Salerno, Pagani, Italy; Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | - Daniela Terracciano
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Jack A Schalken
- Department of Urology, Radboud University Medical Center, Nijmegen, Netherlands
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Hayashi Y, Fujita K. Toward urinary cell-free DNA-based treatment of urothelial carcinoma: a narrative review. Transl Androl Urol 2021; 10:1865-1877. [PMID: 33968675 PMCID: PMC8100839 DOI: 10.21037/tau-20-1259] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Liquid biopsy technique targeting urinary cell-free DNA (cfDNA) is getting a lot of attention to overcome limitations of the present treatment strategy for urothelial carcinoma, including urothelial bladder carcinoma (UBC) and upper tract urothelial carcinoma (UTUC). Analysis of tumor-derived DNA in urine focusing either on genomic or epigenomic alterations, holds great potential as a noninvasive method for the detection of urothelial carcinoma with high accuracy. It is also predictive of prognosis and response to drugs, and reveals the underlying characteristics of different stages of urothelial carcinoma. Although cfDNA methylation analyses based on a combination of several methylation profiles have demonstrated high sensitivity for UBC diagnosis, there have been few reports involving epigenomic studies of urinary cfDNA. In mutational analyses, frequent gene mutations (TERT promoter, TP53, FGFR3, PIK3CA, RAS, etc.) have been detected in urine supernatant by using remarkable technological innovations such as next-generation sequencing and droplet digital PCR. These methods allow highly sensitive detection of rare mutation alleles while minimizing artifacts. In this review, we summarize the current insights into the clinical applications of urinary cfDNA from patients with urothelial carcinoma. Although it is necessary to conduct prospective multi-institutional clinical trials, noninvasive urine biopsy is expected to play an important role in the realization of precision medicine in patients with urothelial carcinoma in the near future.
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Affiliation(s)
- Yujiro Hayashi
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kazutoshi Fujita
- Department of Urology, Kindai University Faculty of Medicine, Osakasayama, Japan
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8
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Chaudhuri AA, Pellini B, Pejovic N, Chauhan PS, Harris PK, Szymanski JJ, Smith ZL, Arora VK. Emerging Roles of Urine-Based Tumor DNA Analysis in Bladder Cancer Management. JCO Precis Oncol 2020; 4:2000060. [PMID: 32923907 DOI: 10.1200/po.20.00060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2020] [Indexed: 12/26/2022] Open
Affiliation(s)
- Aadel A Chaudhuri
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO.,Department of Genetics, Washington University School of Medicine, St Louis, MO.,Department of Computer Science and Engineering, Washington University in St Louis, St Louis, MO.,Department of Biomedical Engineering, Washington University in St Louis, St Louis, MO.,Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Bruna Pellini
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St Louis, MO.,Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO
| | - Nadja Pejovic
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Pradeep S Chauhan
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Peter K Harris
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO
| | - Jeffrey J Szymanski
- Division of Cancer Biology, Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO.,Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Zachary L Smith
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St Louis, MO.,Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Vivek K Arora
- Siteman Cancer Center, Barnes Jewish Hospital and Washington University School of Medicine, St Louis, MO.,Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO
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Tan WS, Teo CH, Chan D, Ang KM, Heinrich M, Feber A, Sarpong R, Williams N, Brew-Graves C, Ng CJ, Kelly J. Exploring patients' experience and perception of being diagnosed with bladder cancer: a mixed-methods approach. BJU Int 2020; 125:669-678. [PMID: 31975539 PMCID: PMC7318301 DOI: 10.1111/bju.15008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Objective To determine patient experience and perception following a diagnosis of non‐muscle‐invasive bladder cancer (NMIBC). Patient and methods Patients were part of a prospective multicentre observational study recruiting patients with NMIBC for a urine biomarker study (DETECT II; ClinicalTrials.gov: NCT02781428). A mixed‐methods approach comprising: (i) the Brief Illness Perception Questionnaire (Brief‐IPQ) and (ii) semi‐structured interviews to explore patients’ experience of having haematuria, and initial and subsequent experience with a NMIBC diagnosis. Both assessments were completed at 6 months after NMIBC diagnosis. Results A total of 213 patients completed the Brief‐IPQ. Patients felt that they had minimal symptoms (median [interquartile range, IQR] score 2 [0–5]) and were not particularly affected emotionally (median [IQR] score 3 [1–6]) with a minimal effect to their daily life (median [IQR] score 2 [0–5]). However, they remained concerned about their cancer diagnosis (median [IQR] score 5 [3–8]) and felt that they had no personal control over the cancer (median [IQR] score 2 [2–5]) and believed that their illness would affect them for some time (median [IQR] score 6 [3–10]). A significant association with a lower personal control of the disease (P < 0.05) and a poorer understanding of the management of NMIBC (P < 0.05) was seen in patients aged >70 years. Many patients were uncertain about the cause of bladder cancer. Qualitative analysis found that at initial presentation of haematuria, most patients were not aware of the risk of bladder cancer. Patients were most anxious and psychologically affected between the interval of cystoscopy diagnosis and transurethral resection of bladder tumour (TURBT). Following TURBT, most patients were positive about their cancer prognosis. Conclusion Patients with NMIBC have a poor perception of disease control and believe that their disease will continue over a prolonged period of time. This is particularly more pertinent in the elderly. Patients are most psychologically affected during the interval between cancer diagnosis following cystoscopy and TURBT. Health awareness about bladder cancer remained poor with a significant number of patients unaware of the causes of bladder cancer. Psychological support and prompt TURBT following bladder cancer diagnosis would help improve the mental health of patients with NMIBC.
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Affiliation(s)
- Wei Shen Tan
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Urology, Northwick Park Hospital, London, UK
| | - Chin Hai Teo
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Delcos Chan
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kar Mun Ang
- Department of Medicine, Royal Free Hospital, London, UK
| | - Malgorzata Heinrich
- Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, London, UK
| | - Andrew Feber
- Division of Surgery and Interventional Science, University College London, London, UK.,UCL Cancer Institute, London, UK
| | - Rachael Sarpong
- Surgical & Interventional Trials Unit, University College London, London, UK
| | - Norman Williams
- Surgical & Interventional Trials Unit, University College London, London, UK
| | - Chris Brew-Graves
- Surgical & Interventional Trials Unit, University College London, London, UK
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - John Kelly
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Urology, University College London Hospital, London, UK
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10
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Tan WS, Ahmad A, Feber A, Mostafid H, Cresswell J, Fankhauser CD, Waisbrod S, Hermanns T, Sasieni P, Kelly JD. Development and validation of a haematuria cancer risk score to identify patients at risk of harbouring cancer. J Intern Med 2019; 285:436-445. [PMID: 30521125 PMCID: PMC6446724 DOI: 10.1111/joim.12868] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND A lack of consensus exists amongst national guidelines regarding who should be investigated for haematuria. Type of haematuria and age-specific thresholds are frequently used to guide referral for the investigation of haematuria. OBJECTIVES To develop and externally validate the haematuria cancer risk score (HCRS) to improve patient selection for the investigation of haematuria. METHODS Development cohort comprise of 3539 prospectively recruited patients recruited at 40 UK hospitals (DETECT 1; ClinicalTrials.gov: NCT02676180) and validation cohort comprise of 656 Swiss patients. All patients were aged >18 years and referred to hospital for the evaluation of visible and nonvisible haematuria. Sensitivity and specificity of the HCRS in the validation cohort were derived from a cut-off identified from the discovery cohort. RESULTS Patient age, gender, type of haematuria and smoking history were used to develop the HCRS. HCRS validation achieves good discrimination (AUC 0.835; 95% CI: 0.789-0.880) and calibration (calibration slope = 1.215) with no significant overfitting (P = 0.151). The HCRS detected 11.4% (n = 8) more cancers which would be missed by UK National Institute for Health and Clinical Excellence guidelines. The American Urological Association guidelines would identify all cancers with a specificity of 12.6% compared to 30.5% achieved by the HCRS. All patients with upper tract cancers would have been identified. CONCLUSION The HCRS offers good discriminatory accuracy which is superior to existing guidelines. The simplicity of the model would facilitate adoption and improve patient and physician decision-making.
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Affiliation(s)
- W. S. Tan
- Division of Surgery & Interventional ScienceUniversity College LondonLondonUK
- Department of UrologyUniversity College London HospitalLondonUK
| | - A. Ahmad
- Cancer IntelligenceCancer Research UKLondonUK
| | - A. Feber
- Division of Surgery & Interventional ScienceUniversity College LondonLondonUK
- UCL Cancer InstituteLondonUK
| | - H. Mostafid
- Department of UrologyRoyal Surrey County HospitalGuildfordUK
| | - J. Cresswell
- Department of UrologyJames Cook University HospitalMiddlesbroughUK
| | - C. D. Fankhauser
- Department of UrologyUniversity Hospital ZurichUniversity of ZurichZurichSwitzerland
| | - S. Waisbrod
- Department of UrologyUniversity Hospital ZurichUniversity of ZurichZurichSwitzerland
| | - T. Hermanns
- Department of UrologyUniversity Hospital ZurichUniversity of ZurichZurichSwitzerland
| | - P. Sasieni
- Faculty of Life Sciences & MedicineSchool of Cancer & Pharmaceutical SciencesInnovation HubGuys Cancer CentreGuys HospitalKing's College LondonLondonUK
| | - J. D. Kelly
- Division of Surgery & Interventional ScienceUniversity College LondonLondonUK
- Department of UrologyUniversity College London HospitalLondonUK
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11
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Tan WS, Teo CH, Chan D, Heinrich M, Feber A, Sarpong R, Allan J, Williams N, Brew-Graves C, Ng CJ, Kelly JD. Mixed-methods approach to exploring patients' perspectives on the acceptability of a urinary biomarker test in replacing cystoscopy for bladder cancer surveillance. BJU Int 2019; 124:408-417. [PMID: 30694612 PMCID: PMC6767410 DOI: 10.1111/bju.14690] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objectives To determine the minimal accepted sensitivity (MAS) of a urine biomarker that patients are willing to accept to replace cystoscopy and to assess qualitatively their views and reasons. Patients and Methods Patients were part of a prospective multicentre observational study recruiting people with bladder cancer for a urine biomarker study (DETECT II; ClinicalTrials.gov: NCT02781428). A mixed‐methods approach comprising (1) a questionnaire to assess patients’ experience with cystoscopy and patients’ preference for cystoscopy vs urinary biomarker, and (2) semi‐structured interviews to understand patient views, choice and reasons for their preference. Results A urine biomarker with an MAS of 90% would be accepted by 75.8% of patients. This was despite a high self‐reported prevalence of haematuria (51.0%), dysuria/lower urinary tract symptoms (69.1%) and urinary tract infection requiring antibiotics (25.8%). There was no association between MAS with patient demographics, adverse events experienced, cancer characteristics or distance of patients’ home to hospital. The qualitative analysis suggested that patients acknowledge that cystoscopy is invasive, embarrassing and associated with adverse events but are willing to tolerate the procedure because of its high sensitivity. Patients have confidence in cystoscopy and appreciate the visual diagnosis of cancer. Both low‐ and high‐risk patients would consider a biomarker with a reported sensitivity similar to that of cystoscopy. Conclusion Patients value the high sensitivity of cystoscopy despite the reported discomfort and adverse events experienced after it. The sensitivity of a urinary biomarker must be close to cystoscopy to gain patients’ acceptance.
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Affiliation(s)
- Wei Shen Tan
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Urology, University College London Hospital, London, UK
| | - Chin Hai Teo
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Delcos Chan
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Malgorzata Heinrich
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK
| | - Andrew Feber
- Division of Surgery and Interventional Science, University College London, London, UK.,UCL Cancer Institute, London, UK
| | - Rachael Sarpong
- Surgical and Interventional Trials Unit, University College London, London, UK
| | - Jennifer Allan
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Norman Williams
- Surgical and Interventional Trials Unit, University College London, London, UK
| | - Chris Brew-Graves
- Surgical and Interventional Trials Unit, University College London, London, UK
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - John D Kelly
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Urology, University College London Hospital, London, UK
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12
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Abstract
Bladder cancer (BC) is a common, significant and expensive health condition. Understanding the risk factors for this disease is paramount to improving disease prevention and increasing public awareness. Historically BC has been a disease of industrialized regions and the most responsible carcinogens are tobacco smoke and occupational chemical exposure. BC incidence and mortality differ dramatically by region and reflect differences in risk factor exposure, healthcare behaviour, and population demographics. Screening studies have suggested a survival benefit amongst screened non-symptomatic populations with known risk factors, but this has not become standard practice.
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Affiliation(s)
| | - Aidan P Noon
- Department of Urology, Royal Hallamshire Hospital, Sheffield, UK
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13
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Tan WS, Sarpong R, Khetrapal P, Rodney S, Mostafid H, Cresswell J, Watson D, Rane A, Hicks J, Hellawell G, Davies M, Srirangam SJ, Dawson L, Payne D, Williams N, Brew‐Graves C, Feber A, Kelly JD. Does urinary cytology have a role in haematuria investigations? BJU Int 2019; 123:74-81. [PMID: 30003675 PMCID: PMC6334509 DOI: 10.1111/bju.14459] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the diagnostic accuracy of urinary cytology to diagnose bladder cancer and upper tract urothelial cancer (UTUC) as well as the outcome of patients with a positive urine cytology and normal haematuria investigations in patients in a multicentre prospective observational study of patients investigated for haematuria. PATIENT AND METHODS The DETECT I study (clinicaltrials.gov NCT02676180) recruited patients presenting with haematuria following referral to secondary case at 40 hospitals. All patients had a cystoscopy and upper tract imaging (renal bladder ultrasound [RBUS] and/ or CT urogram [CTU]). Patients, where urine cytology were performed, were sub-analysed. The reference standard for the diagnosis of bladder cancer and UTUC was histological confirmation of cancer. A positive urine cytology was defined as a urine cytology suspicious for neoplastic cells or atypical cells. RESULTS Of the 3 556 patients recruited, urine cytology was performed in 567 (15.9%) patients from nine hospitals. Median time between positive urine cytology and endoscopic tumour resection was 27 (IQR: 21.3-33.8) days. Bladder cancer was diagnosed in 39 (6.9%) patients and UTUC in 8 (1.4%) patients. The accuracy of urinary cytology for the diagnosis of bladder cancer and UTUC was: sensitivity 43.5%, specificity 95.7%, positive predictive value (PPV) 47.6% and negative predictive value (NPV) 94.9%. A total of 21 bladder cancers and 5 UTUC were missed. Bladder cancers missed according to grade and stage were as follows: 4 (19%) were ≥ pT2, 2 (9.5%) were G3 pT1, 10 (47.6%) were G3/2 pTa and 5 (23.8%) were G1 pTa. High-risk cancer was confirmed in 8 (38%) patients. There was a marginal improvement in sensitivity (57.7%) for high-risk cancers. When urine cytology was combined with imaging, the diagnostic performance improved with CTU (sensitivity 90.2%, specificity 94.9%) superior to RBUS (sensitivity 66.7%, specificity 96.7%). False positive cytology results were confirmed in 22 patients, of which 12 (54.5%) had further invasive tests and 5 (22.7%) had a repeat cytology. No cancer was identified in these patients during follow-up. CONCLUSIONS Urine cytology will miss a significant number of muscle-invasive bladder cancer and high-risk disease. Our results suggest that urine cytology should not be routinely performed as part of haematuria investigations. The role of urine cytology in select cases should be considered in the context of the impact of a false positive result leading to further potentially invasive tests conducted under general anaesthesia.
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Affiliation(s)
- Wei Shen Tan
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- Department of UrologyUniversity College London HospitalLondonUK
| | - Rachael Sarpong
- Surgical and Interventional Trials UnitUniversity College LondonLondonUK
| | - Pramit Khetrapal
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- Department of UrologyUniversity College London HospitalLondonUK
| | - Simon Rodney
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- UCL Cancer InstituteLondonUK
| | - Hugh Mostafid
- Department of UrologyRoyal Surrey County HospitalGuildfordUK
| | - Joanne Cresswell
- Department of UrologyJames Cook University HospitalMiddlesbroughUK
| | - Dawn Watson
- Department of UrologyJames Cook University HospitalMiddlesbroughUK
| | - Abhay Rane
- Department of UrologyEast Surrey HospitalRedhillUK
| | - James Hicks
- Department of UrologyWorthing HospitalWorthingUK
| | | | - Melissa Davies
- Department of UrologySalisbury District HospitalSalisburyUK
| | | | | | - David Payne
- Department of UrologyKettering General HospitalKetteringUK
| | - Norman Williams
- Surgical and Interventional Trials UnitUniversity College LondonLondonUK
| | - Chris Brew‐Graves
- Surgical and Interventional Trials UnitUniversity College LondonLondonUK
| | - Andrew Feber
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- UCL Cancer InstituteLondonUK
| | - John D. Kelly
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- Department of UrologyUniversity College London HospitalLondonUK
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14
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Tan WS, Feber A, Sarpong R, Khetrapal P, Rodney S, Jalil R, Mostafid H, Cresswell J, Hicks J, Rane A, Henderson A, Watson D, Cherian J, Williams N, Brew-Graves C, Kelly JD. Who Should Be Investigated for Haematuria? Results of a Contemporary Prospective Observational Study of 3556 Patients. Eur Urol 2018; 74:10-14. [DOI: 10.1016/j.eururo.2018.03.008] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 03/07/2018] [Indexed: 11/26/2022]
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15
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Tan WS, Sarpong R, Khetrapal P, Rodney S, Mostafid H, Cresswell J, Hicks J, Rane A, Henderson A, Watson D, Cherian J, Williams N, Brew-Graves C, Feber A, Kelly JD. Can Renal and Bladder Ultrasound Replace Computerized Tomography Urogram in Patients Investigated for Microscopic Hematuria? J Urol 2018; 200:973-980. [PMID: 29702097 PMCID: PMC6179963 DOI: 10.1016/j.juro.2018.04.065] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2018] [Indexed: 11/24/2022]
Abstract
Purpose Computerized tomography urogram is recommended when investigating patients with hematuria. We determined the incidence of urinary tract cancer and compared the diagnostic accuracy of computerized tomography urogram to that of renal and bladder ultrasound for identifying urinary tract cancer. Materials and Methods The DETECT (Detecting Bladder Cancer Using the UroMark Test) I study is a prospective observational study recruiting patients 18 years old or older following presentation with macroscopic or microscopic hematuria at a total of 40 hospitals. All patients underwent cystoscopy and upper tract imaging comprising computerized tomography urogram and/or renal and bladder ultrasound. Results A total of 3,556 patients with a median age of 68 years were recruited in this study, of whom 2,166 underwent renal and bladder ultrasound, and 1,692 underwent computerized tomography urogram in addition to cystoscopy. The incidence of bladder, renal and upper tract urothelial cancer was 11.0%, 1.4% and 0.8%, respectively, in macroscopic hematuria cases. Patients with microscopic hematuria had a 2.7%, 0.4% and 0% incidence of bladder, renal and upper tract urothelial cancer, respectively. The sensitivity and negative predictive value of renal and bladder ultrasound to detect renal cancer were 85.7% and 99.9% but they were 14.3% and 99.7%, respectively, to detect upper tract urothelial cancer. Renal and bladder ultrasound was poor at identifying renal calculi. Renal and bladder ultrasound sensitivity was lower than that of computerized tomography urogram to detect bladder cancer (each less than 85%). Cystoscopy had 98.3% specificity and 83.9% positive predictive value. Conclusions Computerized tomography urogram can be safely replaced by renal and bladder ultrasound in patients who have microscopic hematuria. The incidence of upper tract urothelial cancer is 0.8% in patients with macroscopic hematuria and computerized tomography urogram is recommended. Patients with suspected renal calculi require noncontrast renal tract computerized tomography. Imaging cannot replace cystoscopy to diagnose bladder cancer.
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Affiliation(s)
- Wei Shen Tan
- Division of Surgery and Interventional Science (SR), University College London, London, United Kingdom; Surgical and Interventional Trials Unit (RS, NW, CB-G), University College London, London, United Kingdom; Department of Urology, University College London Hospital (WST, PK, JDK), London, United Kingdom; University College London Cancer Institute (SR, AF), London, United Kingdom; Department of Urology, Royal Surrey County Hospital (HM), Guildford, United Kingdom; Department of Urology, James Cook University Hospital (JC), Middlesbrough, United Kingdom; Department of Urology, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital (JH), Worthing, United Kingdom; Department of Urology, East Surrey Hospital (AR), Redhill, United Kingdom; Department of Urology, Maidstone Hospital (AH), Maidstone, United Kingdom; Department of Urology, Pennine Acute Hospitals NHS Trust, North Manchester General Hospital (JC), Crumpsall, United Kingdom.
| | - Rachael Sarpong
- Division of Surgery and Interventional Science (SR), University College London, London, United Kingdom; Surgical and Interventional Trials Unit (RS, NW, CB-G), University College London, London, United Kingdom; Department of Urology, University College London Hospital (WST, PK, JDK), London, United Kingdom; University College London Cancer Institute (SR, AF), London, United Kingdom; Department of Urology, Royal Surrey County Hospital (HM), Guildford, United Kingdom; Department of Urology, James Cook University Hospital (JC), Middlesbrough, United Kingdom; Department of Urology, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital (JH), Worthing, United Kingdom; Department of Urology, East Surrey Hospital (AR), Redhill, United Kingdom; Department of Urology, Maidstone Hospital (AH), Maidstone, United Kingdom; Department of Urology, Pennine Acute Hospitals NHS Trust, North Manchester General Hospital (JC), Crumpsall, United Kingdom
| | - Pramit Khetrapal
- Division of Surgery and Interventional Science (SR), University College London, London, United Kingdom; Surgical and Interventional Trials Unit (RS, NW, CB-G), University College London, London, United Kingdom; Department of Urology, University College London Hospital (WST, PK, JDK), London, United Kingdom; University College London Cancer Institute (SR, AF), London, United Kingdom; Department of Urology, Royal Surrey County Hospital (HM), Guildford, United Kingdom; Department of Urology, James Cook University Hospital (JC), Middlesbrough, United Kingdom; Department of Urology, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital (JH), Worthing, United Kingdom; Department of Urology, East Surrey Hospital (AR), Redhill, United Kingdom; Department of Urology, Maidstone Hospital (AH), Maidstone, United Kingdom; Department of Urology, Pennine Acute Hospitals NHS Trust, North Manchester General Hospital (JC), Crumpsall, United Kingdom
| | - Simon Rodney
- Division of Surgery and Interventional Science (SR), University College London, London, United Kingdom; Surgical and Interventional Trials Unit (RS, NW, CB-G), University College London, London, United Kingdom; Department of Urology, University College London Hospital (WST, PK, JDK), London, United Kingdom; University College London Cancer Institute (SR, AF), London, United Kingdom; Department of Urology, Royal Surrey County Hospital (HM), Guildford, United Kingdom; Department of Urology, James Cook University Hospital (JC), Middlesbrough, United Kingdom; Department of Urology, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital (JH), Worthing, United Kingdom; Department of Urology, East Surrey Hospital (AR), Redhill, United Kingdom; Department of Urology, Maidstone Hospital (AH), Maidstone, United Kingdom; Department of Urology, Pennine Acute Hospitals NHS Trust, North Manchester General Hospital (JC), Crumpsall, United Kingdom
| | - Hugh Mostafid
- Division of Surgery and Interventional Science (SR), University College London, London, United Kingdom; Surgical and Interventional Trials Unit (RS, NW, CB-G), University College London, London, United Kingdom; Department of Urology, University College London Hospital (WST, PK, JDK), London, United Kingdom; University College London Cancer Institute (SR, AF), London, United Kingdom; Department of Urology, Royal Surrey County Hospital (HM), Guildford, United Kingdom; Department of Urology, James Cook University Hospital (JC), Middlesbrough, United Kingdom; Department of Urology, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital (JH), Worthing, United Kingdom; Department of Urology, East Surrey Hospital (AR), Redhill, United Kingdom; Department of Urology, Maidstone Hospital (AH), Maidstone, United Kingdom; Department of Urology, Pennine Acute Hospitals NHS Trust, North Manchester General Hospital (JC), Crumpsall, United Kingdom
| | - Joanne Cresswell
- Division of Surgery and Interventional Science (SR), University College London, London, United Kingdom; Surgical and Interventional Trials Unit (RS, NW, CB-G), University College London, London, United Kingdom; Department of Urology, University College London Hospital (WST, PK, JDK), London, United Kingdom; University College London Cancer Institute (SR, AF), London, United Kingdom; Department of Urology, Royal Surrey County Hospital (HM), Guildford, United Kingdom; Department of Urology, James Cook University Hospital (JC), Middlesbrough, United Kingdom; Department of Urology, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital (JH), Worthing, United Kingdom; Department of Urology, East Surrey Hospital (AR), Redhill, United Kingdom; Department of Urology, Maidstone Hospital (AH), Maidstone, United Kingdom; Department of Urology, Pennine Acute Hospitals NHS Trust, North Manchester General Hospital (JC), Crumpsall, United Kingdom
| | - James Hicks
- Division of Surgery and Interventional Science (SR), University College London, London, United Kingdom; Surgical and Interventional Trials Unit (RS, NW, CB-G), University College London, London, United Kingdom; Department of Urology, University College London Hospital (WST, PK, JDK), London, United Kingdom; University College London Cancer Institute (SR, AF), London, United Kingdom; Department of Urology, Royal Surrey County Hospital (HM), Guildford, United Kingdom; Department of Urology, James Cook University Hospital (JC), Middlesbrough, United Kingdom; Department of Urology, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital (JH), Worthing, United Kingdom; Department of Urology, East Surrey Hospital (AR), Redhill, United Kingdom; Department of Urology, Maidstone Hospital (AH), Maidstone, United Kingdom; Department of Urology, Pennine Acute Hospitals NHS Trust, North Manchester General Hospital (JC), Crumpsall, United Kingdom
| | - Abhay Rane
- Division of Surgery and Interventional Science (SR), University College London, London, United Kingdom; Surgical and Interventional Trials Unit (RS, NW, CB-G), University College London, London, United Kingdom; Department of Urology, University College London Hospital (WST, PK, JDK), London, United Kingdom; University College London Cancer Institute (SR, AF), London, United Kingdom; Department of Urology, Royal Surrey County Hospital (HM), Guildford, United Kingdom; Department of Urology, James Cook University Hospital (JC), Middlesbrough, United Kingdom; Department of Urology, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital (JH), Worthing, United Kingdom; Department of Urology, East Surrey Hospital (AR), Redhill, United Kingdom; Department of Urology, Maidstone Hospital (AH), Maidstone, United Kingdom; Department of Urology, Pennine Acute Hospitals NHS Trust, North Manchester General Hospital (JC), Crumpsall, United Kingdom
| | - Alastair Henderson
- Division of Surgery and Interventional Science (SR), University College London, London, United Kingdom; Surgical and Interventional Trials Unit (RS, NW, CB-G), University College London, London, United Kingdom; Department of Urology, University College London Hospital (WST, PK, JDK), London, United Kingdom; University College London Cancer Institute (SR, AF), London, United Kingdom; Department of Urology, Royal Surrey County Hospital (HM), Guildford, United Kingdom; Department of Urology, James Cook University Hospital (JC), Middlesbrough, United Kingdom; Department of Urology, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital (JH), Worthing, United Kingdom; Department of Urology, East Surrey Hospital (AR), Redhill, United Kingdom; Department of Urology, Maidstone Hospital (AH), Maidstone, United Kingdom; Department of Urology, Pennine Acute Hospitals NHS Trust, North Manchester General Hospital (JC), Crumpsall, United Kingdom
| | - Dawn Watson
- Division of Surgery and Interventional Science (SR), University College London, London, United Kingdom; Surgical and Interventional Trials Unit (RS, NW, CB-G), University College London, London, United Kingdom; Department of Urology, University College London Hospital (WST, PK, JDK), London, United Kingdom; University College London Cancer Institute (SR, AF), London, United Kingdom; Department of Urology, Royal Surrey County Hospital (HM), Guildford, United Kingdom; Department of Urology, James Cook University Hospital (JC), Middlesbrough, United Kingdom; Department of Urology, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital (JH), Worthing, United Kingdom; Department of Urology, East Surrey Hospital (AR), Redhill, United Kingdom; Department of Urology, Maidstone Hospital (AH), Maidstone, United Kingdom; Department of Urology, Pennine Acute Hospitals NHS Trust, North Manchester General Hospital (JC), Crumpsall, United Kingdom
| | - Jacob Cherian
- Division of Surgery and Interventional Science (SR), University College London, London, United Kingdom; Surgical and Interventional Trials Unit (RS, NW, CB-G), University College London, London, United Kingdom; Department of Urology, University College London Hospital (WST, PK, JDK), London, United Kingdom; University College London Cancer Institute (SR, AF), London, United Kingdom; Department of Urology, Royal Surrey County Hospital (HM), Guildford, United Kingdom; Department of Urology, James Cook University Hospital (JC), Middlesbrough, United Kingdom; Department of Urology, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital (JH), Worthing, United Kingdom; Department of Urology, East Surrey Hospital (AR), Redhill, United Kingdom; Department of Urology, Maidstone Hospital (AH), Maidstone, United Kingdom; Department of Urology, Pennine Acute Hospitals NHS Trust, North Manchester General Hospital (JC), Crumpsall, United Kingdom
| | - Norman Williams
- Division of Surgery and Interventional Science (SR), University College London, London, United Kingdom; Surgical and Interventional Trials Unit (RS, NW, CB-G), University College London, London, United Kingdom; Department of Urology, University College London Hospital (WST, PK, JDK), London, United Kingdom; University College London Cancer Institute (SR, AF), London, United Kingdom; Department of Urology, Royal Surrey County Hospital (HM), Guildford, United Kingdom; Department of Urology, James Cook University Hospital (JC), Middlesbrough, United Kingdom; Department of Urology, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital (JH), Worthing, United Kingdom; Department of Urology, East Surrey Hospital (AR), Redhill, United Kingdom; Department of Urology, Maidstone Hospital (AH), Maidstone, United Kingdom; Department of Urology, Pennine Acute Hospitals NHS Trust, North Manchester General Hospital (JC), Crumpsall, United Kingdom
| | - Chris Brew-Graves
- Division of Surgery and Interventional Science (SR), University College London, London, United Kingdom; Surgical and Interventional Trials Unit (RS, NW, CB-G), University College London, London, United Kingdom; Department of Urology, University College London Hospital (WST, PK, JDK), London, United Kingdom; University College London Cancer Institute (SR, AF), London, United Kingdom; Department of Urology, Royal Surrey County Hospital (HM), Guildford, United Kingdom; Department of Urology, James Cook University Hospital (JC), Middlesbrough, United Kingdom; Department of Urology, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital (JH), Worthing, United Kingdom; Department of Urology, East Surrey Hospital (AR), Redhill, United Kingdom; Department of Urology, Maidstone Hospital (AH), Maidstone, United Kingdom; Department of Urology, Pennine Acute Hospitals NHS Trust, North Manchester General Hospital (JC), Crumpsall, United Kingdom
| | - Andrew Feber
- Division of Surgery and Interventional Science (SR), University College London, London, United Kingdom; Surgical and Interventional Trials Unit (RS, NW, CB-G), University College London, London, United Kingdom; Department of Urology, University College London Hospital (WST, PK, JDK), London, United Kingdom; University College London Cancer Institute (SR, AF), London, United Kingdom; Department of Urology, Royal Surrey County Hospital (HM), Guildford, United Kingdom; Department of Urology, James Cook University Hospital (JC), Middlesbrough, United Kingdom; Department of Urology, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital (JH), Worthing, United Kingdom; Department of Urology, East Surrey Hospital (AR), Redhill, United Kingdom; Department of Urology, Maidstone Hospital (AH), Maidstone, United Kingdom; Department of Urology, Pennine Acute Hospitals NHS Trust, North Manchester General Hospital (JC), Crumpsall, United Kingdom
| | - John D Kelly
- Division of Surgery and Interventional Science (SR), University College London, London, United Kingdom; Surgical and Interventional Trials Unit (RS, NW, CB-G), University College London, London, United Kingdom; Department of Urology, University College London Hospital (WST, PK, JDK), London, United Kingdom; University College London Cancer Institute (SR, AF), London, United Kingdom; Department of Urology, Royal Surrey County Hospital (HM), Guildford, United Kingdom; Department of Urology, James Cook University Hospital (JC), Middlesbrough, United Kingdom; Department of Urology, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital (JH), Worthing, United Kingdom; Department of Urology, East Surrey Hospital (AR), Redhill, United Kingdom; Department of Urology, Maidstone Hospital (AH), Maidstone, United Kingdom; Department of Urology, Pennine Acute Hospitals NHS Trust, North Manchester General Hospital (JC), Crumpsall, United Kingdom
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- Division of Surgery and Interventional Science (SR), University College London, London, United Kingdom; Surgical and Interventional Trials Unit (RS, NW, CB-G), University College London, London, United Kingdom; Department of Urology, University College London Hospital (WST, PK, JDK), London, United Kingdom; University College London Cancer Institute (SR, AF), London, United Kingdom; Department of Urology, Royal Surrey County Hospital (HM), Guildford, United Kingdom; Department of Urology, James Cook University Hospital (JC), Middlesbrough, United Kingdom; Department of Urology, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital (JH), Worthing, United Kingdom; Department of Urology, East Surrey Hospital (AR), Redhill, United Kingdom; Department of Urology, Maidstone Hospital (AH), Maidstone, United Kingdom; Department of Urology, Pennine Acute Hospitals NHS Trust, North Manchester General Hospital (JC), Crumpsall, United Kingdom
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Tan WS, Tan WP. Urinary biomarker for the detection of recurrence following non-muscle invasive bladder cancer: are we there yet? Transl Androl Urol 2018; 7:S109-S110. [PMID: 29644175 PMCID: PMC5881187 DOI: 10.21037/tau.2017.12.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Wei Shen Tan
- Division of Surgery & Interventional Science, University College London, London, UK.,Department of Urology, University College London Hospital, London, UK
| | - Wei Phin Tan
- Division of Urology, Rush University Medical Center, Chicago, IL, USA
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