Inter-reader reliability of the vesical imaging-reporting and data system (VI-RADS) for muscle-invasive bladder cancer: a systematic review and meta-analysis

Urodrill - a novel MRI-guided endoscopic biopsy technique to sample and molecularly classify muscle-invasive bladder cancer without fractionating the specimen during transurethral resection

“…Two relevant issues emerged during the study: interindividual complexity related to tumor location and a need for assistant support of the flexible cystoscope when sampling in female patients. Limitations related to the specificity of MRI for identification of MIBC suggest a remaining need for biopsies [4] , which is exemplified by the patient excluded from the present series because of benign histology. Furthermore, urine cytology cannot identify histological subtypes and thus cannot guide changes in chemotherapy, such as for patient 5 in this study (Sc/Ne histology), for whom combinations with etoposide would be more suitable than standard platinum-based regimens [10] .…”

“…Thus, the ideal diagnostic pathway would separate Ta/T1 from MIBC early on, for which a suggested feasible option is magnetic resonance imaging (MRI) with use of the Vesical Imaging-Reporting and Data System (VI-RADS) [4] . However, evaluation of this MRI-based pathway in the randomized BladderPath study revealed that one-third of patients diagnosed with MIBC according to MRI turned out to have NMIBC [5] .…”

“…Ten consecutively identified patients with radiological suspicion on CT urography of MIBC were recruited between March 2021 and September 2022 in a tertiary referral center [4] . One additional patient was excluded, as benign prostatic enlargement was the cause of endoscopic and radiologic suspicion of MIBC.…”

Editorial for “Detecting Muscle Invasion of Bladder Cancer: An Application of Diffusion Kurtosis Imaging Ratio and Vesical Imaging‐Reporting and Data System”

“…T he rapid increase of numerous standardized imaging reporting and data systems such as liver, prostate, and vesicle imaging reporting and data systems (LI-RADS, PI-RADS, and VI-RADS, respectively) has further elucidated the limitations of subjective human interpretation in terms of reproducibility and accuracy. [1][2][3][4] In an effort to improve upon these inherent limitations there has been ongoing research in the field of quantitative imaging biomarkers. These biomarkers, derived from the image data itself have shown great potential in answering numerous clinical questions.…”

“…In a meta‐analysis of 19 studies a VI‐RADS score of 4 was shown to predict muscle invasion with 78% sensitivity and 96% specificity 3 . A meta‐analysis exploring VI‐RADS inter‐reader agreement in VI‐RADS showed Kappa varying from 0.45 to 0.96 and averaging 0.76 in 19 studies 4 . In spite of the relatively high accuracy and inter‐reader agreement as compared to the more traditional, invasive approach of TURBT, there remains plenty of room for improvement.…”