The accuracy of Vesical Imaging-Reporting and Data System (VI-RADS): an updated comprehensive multi-institutional, multi-readers systematic review and meta-analysis from diagnostic evidence into future clinical recommendations

Abstract

Purpose To determine through a comprehensive systematic review and meta-analysis the cumulative diagnostic performance of vesical imaging-reporting and data system (VIRADS) to predict preoperative muscle-invasiveness among different institutions, readers, and optimal scoring accuracy thresholds. Methods PubMed, Cochrane and Embase were searched from inception up to May 2021. Sensitivity (Sn), Specificity (Sp) were first estimated and subsequently pooled using hierarchical summary receiver operating characteristics (HSROC) modeling for both cut-off ≥ 3 and ≥ 4 to predict muscle-invasive bladder cancer (MIBC). Further sensitivity analysis, subgroup analysis and meta-regression were conducted to investigate contribution of moderators to heterogeneity. Results In total, n = 20 studies from 2019 to 2021 with n = 2477 patients by n = 53 genitourinary radiologists met the inclusion criteria. Pooled weighted Sn and Sp were 0.87 (95% CI 0.82–0.91) and 0.86 (95% CI 0.80–0.90) for cut-off ≥ 3 while 0.78 (95% CI 0.74–0.81) and 0.94 (95% CI 0.91–0.96) for cut-off ≥ 4. The area under the HSROC curve was 0.93 (95% CI 0.90–0.95) and 0.91 (95% CI 0.88–0.93) for cut-off ≥ 3 and ≥ 4, respectively. Meta-regression analyses showed no influence of clinical characteristics nor cumulative reader’s experience while study design and radiological characteristics were found to influence the estimated outcome. Conclusion We demonstrated excellent worldwide diagnostic performance of VI-RADS to determine pre-trans urethral resection of bladder tumor (TURBT) staging. Our findings corroborate wide reliability of VI-RADS accuracy also between different centers with varying experience underling the importance that standardization and reproducibility of VI-RADS may confer to multiparametric magnetic resonance imaging (mpMRI) for preoperative BCa discrimination.

Lymphocyte-to-Monocyte Ratio (LMR) During Induction Is a Better Predictor Than Preoperative LMR in Patients Receiving Intravesical Bacillus Calmette -Guerin for Non-Muscle-Invasive Bladder Cancer

“…Recently, various biomarkers, including clinical and basic methods, are appearing (30)(31)(32)(33)(34)(35). For instance, vesical imagingreporting and data system (VIRADS) can determine the preoperative stage of TURBT (30,31).…”

“…Recently, various biomarkers, including clinical and basic methods, are appearing (30)(31)(32)(33)(34)(35). For instance, vesical imagingreporting and data system (VIRADS) can determine the preoperative stage of TURBT (30,31). The combination of imaging and ILMR may more accurately screen out patients who have no response to BCG and should accept early aggressive treatment.…”

The use of MRI in urothelial carcinoma

“…VI-RADS clinical impact and mpMRI of the bladder diagnostic performance have been widely investigated and validated, proving the high accuracy and reliability, especially thanks to the strong inter-reader agreement, as indicated by numerous level 2a original investigations and meta-analyses (Table 1) [27 ▪ ,28 ▪ ,29 ▪ ,30 ▪ ,31 ▪ ,32–42].…”

“…A most recent review and meta-analysis, including 20 studies and 2477 patients, demonstrated VI-RADS strong diagnostic performance in the pre-TURBT staging, with pooled sensitivity and specificity of 0.78 (95% CI 0.74–0.81) and 0.94 (95% CI 0.91–0.96), respectively [27 ▪ ].…”

Diagnostic Value of the Vesical Imaging-Reporting and Data System in Bladder Urothelial Carcinoma with Variant Histology

“…The Vesical Imaging-Reporting and Data System (VI-RADS) is a standardized reporting system for detection of muscle-invasive BC (MIBC) via multiparametric magnetic resonance imaging (mpMRI) in patients with PUC [4]. VI-RADS is highly accurate in discriminating MIBC from non-MIBC (NMIBC) and has good inter-reader agreement in PUC [5][6][7]. However, the usefulness of VI-RADS in VUC remains unknown.…”