MP06-08 WHO SHOULD BE EVALUATED FOR HEMATURIA? A COMPARISON OF INTERNATIONAL GUIDELINES

Abstract

You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation I1 Apr 2018MP06-08 WHO SHOULD BE EVALUATED FOR HEMATURIA? A COMPARISON OF INTERNATIONAL GUIDELINES Wei Shen Tan, Andrew Feber, Liqin Dong, Rachael Sarpong, Simon Rodney, Pramit Khetrapal, Patricia de Winter, Rumana Jalil, Norman Williams, Chris Brew-Graves, John Kelly, and DETECT I trial group Wei Shen TanWei Shen Tan More articles by this author , Andrew FeberAndrew Feber More articles by this author , Liqin DongLiqin Dong More articles by this author , Rachael SarpongRachael Sarpong More articles by this author , Simon RodneySimon Rodney More articles by this author , Pramit KhetrapalPramit Khetrapal More articles by this author , Patricia de WinterPatricia de Winter More articles by this author , Rumana JalilRumana Jalil More articles by this author , Norman WilliamsNorman Williams More articles by this author , Chris Brew-GravesChris Brew-Graves More articles by this author , John KellyJohn Kelly More articles by this author , and DETECT I trial groupDETECT I trial group More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.200AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES ematuria is associated with an increased risk for urinary tract cancer (UTC). The American Urology Association (AUA) recommendation is that any patient presenting with gross haematuria (GH) and patients aged ≥ 35 years with asymptomatic microscopic hematuria (MH) should be investigated. The UK National Institute for Health and Care Excellence (NICE) recommended that patients aged ≥ 45 years with GH and ≥ 60 years with unexplained MH with either dysuria or a raised white cell count on blood test should be investigated. In this multicentre study, we compared hematuria guidelines to determine the appropriate age-dependent threshold for investigations. W also determined the incidence of bladder cancer, upper tract tumours and clinical-pathological characteristics according to type of hematuria. METHODS DETECT I (clinicaltrials.gov NCT02676180) is a multicentre observational study to determine the diagnostic accuracy of a urinary biomarker test for the detection of bladder. The study recruited patients refereed from primary care to any of 40 hospitals following a presentation of hematuria. All patients had a cystoscopy and upper tract imaging. Patients with a suspicion of bladder cancer had transurethral resection of bladder cancer or bladder biopsy for histological confirmation of cancer. RESULTS 3561 patients with a median age of 68 years were recruited over a 14-month period. GH represents 65% of patients referred for investigations. GH, increasing age, male patients and smoking history were independently associated with a diagnosis of UTC (all ≤0.05) on multiple logistic regression. The overall incidence of UTC was 10% (bladder cancer: 8.0%, renal parenchymal cancer 1.1%, Upper tract transitional cell carcinoma (TCC): 0.7%). The AUA guidance would identify all patients diagnosed with UTC in this patient cohort. Adopting the NICE guidance would miss 11 UTC (10 bladder cancers, 1 upper tract TCC). This represents 3.5% of bladder cancers and 3.8% of upper tract TCC. 70% of bladder cancers missed are intermediate to high risk disease including one ≥pT2 cancer. Of the 11 UTC missed, 4 missed bladder cancers presented with MH. 61% of patients presenting with MH have high risk bladder cancer with 32% of them ≥pT2. CONCLUSIONS Applying the NICE criteria to select patients for hematuria investigation will miss a significant number of cancers including those with clinically significant disease. The AUA guidance will identify all UTC in this study. Hematuria investigations cannot be safely avoided in patients with GH regardless of age and those ≥ 35 years with MH. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e54-e55 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Wei Shen Tan More articles by this author Andrew Feber More articles by this author Liqin Dong More articles by this author Rachael Sarpong More articles by this author Simon Rodney More articles by this author Pramit Khetrapal More articles by this author Patricia de Winter More articles by this author Rumana Jalil More articles by this author Norman Williams More articles by this author Chris Brew-Graves More articles by this author John Kelly More articles by this author DETECT I trial group More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...