The efficacy and reliability of VI‐RADS in determining candidates for repeated transurethral resection in patients with high‐risk non‐muscle invasive bladder cancer

Abstract

Objective Our study aims to evaluate the efficiency and reliability of Vesical Imaging Reporting Data System (VI‐RADS) in prospectively identifying the patients to undergo RE‐TURBT in the management of patients with high‐risk non‐muscle invasive Bladder Cancer(HR‐NMIBC).The secondary objective was to evaluate the performance of the VI‐RADS scoring system in differentiating between muscle‐invasive bladder cancer (MIBC) and non‐muscle invasive bladder cancer(NMIBC) prospectively. Methods The study included 330 patients who underwent transurethral resection of bladder tumour(TURBT) for Bladder Cancer (BC) in our clinic. All patients underwent multiparametric‐magnetic resonance imaging (Mp‐MRI) before the operation and VI‐RADS scoring was administered. The cut‐off value of VI‐RADS was accepted as three and above. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for the differentiation between NMIBC and MIBC distinction in all patients. Receiver operating characteristic (ROC) analysis was performed to evaluate the performance of the VI‐RADS scoring system. In the second phase of the study, patients with MIBC and low‐risk NMIBC (LR‐NMBIC) were excluded and 158 patients with HR‐NMIBC were included, and their sensitivity, specificity, PPV and NPV values were measured. ROC analysis was performed. Results In all patients, sensitivity, specificity, PPV and NPV values of the VI‐RADS scoring in the differentiation of MIBC and NMIBC were 91.3, 91.8, 81.7 and 96.3 respectively. The AUC value was 0.934 (95%CI: 0.903‐0.964). Sensitivity, specificity, PPV and NPV values were found to be 87, 91.8, 74.1, 95.2 in the evaluation specifically made for patients with HR‐NMIBC. The AUC value was 0.900 (95% CI:0.843‐0.957). Inter‐reader agreement was excellent (Ƙ = 0.90, 95% CI:0.71‐0.95). Conclusions The VI‐RADS scoring system is an effective and reliable method in determining the patients who will undergo RE‐TURBT and in differentiating MIBC and NMIBC.

Risk Stratification for the Rate and Location of Residual Bladder Tumor for the Decision of Re-Transurethral Resection of Bladder Tumor

“…Giudice et al prospectively collected the data of 231 patients who underwent mp-MRI before initial TURBT and found that the sensitivity, specificity of mp-MRI to identify patients with MIBC at re-TURBT was 85% (95% CI: 62-96.8%) and 93.6% (95% CI: 86.6-97.6), respectively (33). Moreover, a study also documented that mp-MRI with a vesical imaging reporting and data system (VI-RADS) was an effective and reliable method to determine the patients who could benefit from re-TURBT (34). Furthermore, in the era of big data and precision medicine, not only mp-MRI, but also artificial intelligence (35) and molecular biomarkers (36) have become promising tools to identify patients with BCa who will benefit more from re-TURBT.…”

Is high accuracy of Vesical Imaging-Reporting and Data System (VI-RADS) sufficient for its implementation in the urological practice?

“…VI-RADS has been proposed to reduce the risk of understaging, particularly in high-risk patients, and reduce the need for reTURBT (ref. 11 ).…”

“…However, Erkoc et al reported up to 8% incidence of MIBC in group VI-RADS 2 (ref. 11 ). VI-RADS 3 represents a "gray zone", which is often considered as a cut-off for muscle invasion.…”

Nuevas herramientas para el diagnóstico del cáncer de vejiga

“…La clasificación VI-RADS, se ha empezado a utilizar en el pronóstico tras los múltiples tratamientos posibles. Ercok el al., (50) incluyo 158 paciente llevados a Re-RTUV con una RMmp previa al procedimiento, 25.3 % fue re estadificado como TMI tras la patología. Las imágenes prequirúrgicas mostraron una sensibilidad del 87%, especificidad del 91% y una AUC 0.9 diagnosticando adecuadamente TMI antes de ser llevados a RTUV.…”