VI-RADS-Based Algorithm for Bladder Cancer Management Randomized Retrospective Study - Beyond the Abstract
February 24, 2025
To evaluate if VI-RADS can distinguish between non-muscle-invasive bladder cancers (NMIBC), muscle-invasive bladder cancer (MIBC), and high-risk non-muscle-invasive bladder cancers (HR-NMIBCs). It is unclear if the Vesical Imaging-Reporting and Data System (VI-RADS) can replace repeated transurethral resection of bladder tumour (Re-TURBT) as in the new VI-RADS-based algorithm.
Biographies:
Merve Şam Özdemir, Department of Radiology, Başaksehir Çam and Sakura City Hospital, Istanbul, Turkey
Biographies:
Merve Şam Özdemir, Department of Radiology, Başaksehir Çam and Sakura City Hospital, Istanbul, Turkey
Read the Full Video Transcript
Merve Şam Özdemir: Patients and methods. The MRI was performed on a 3 Tesla MRI scanner using sequences according to the VI-RADS protocol. All examinations were reviewed by an experienced urogenital radiologist blinded to the clinical information. The reader also assigned a VI-RADS score to each lesion up to three per patient, and only the one with the highest VI-RADS score was considered for each patient.
All patients underwent conventional bipolar white light TURBT at our institution within six weeks of NP MRI. For all T1 patients, as well as patients with high risk TA deficient muscularis propria in the resection specimen, three TURBT was performed at the score site or initial rejection site by the same two experienced surgeons within two to six weeks after the initial surgery.
All tumor samples were analyzed by two experienced neuropathologists. In this study, data were analyzed by SPSS 22.0. ROC analysis was used to predict the success of NP MRI in distinguishing between non-MIBC and MIBC. The specificity, sensitivity, and negative positive predictive values were calculated for the MP MRI. The P value was accepted as less than 0.05 at a 95% confidence interval.
Results. A total of 283 patients underwent MP MRI before TURBT. The clinical characteristics and tumor characteristics of the entire population are summarized in table 1. VI-RADS and final pathologies of the patients were compared with in table 2. The performance of the MP MRI in distinguishing non-MIBC from MIBC tumors in 283 cases.
When VI-RADS 3 and higher lesions were considered muscle invasive, its sensitivity was 95.7%, and its specificity was 92.5. PPV and NPV were 86.6% and 97.7% respectively. When VI-RADS 4 and higher lesions were considered muscle invasive, the sensitivity was 77.8%, and the specificity was 99.4%.
PPV and NPV were 98.6% and 89.9% respectively. At baseline TURBT, 77 patients with MIBC, 80 with low risk non-MIBC, and 37 bit with carcinoma in-situ were excluded. A total of 89 patients were evaluated for the final analysis. Clinical and tumor characteristics of high risk non-MIBC patients are summarized in table 3. If the new VI-RADS-based approach was used, 73 of 178 high risk non-MIBC patients with VI-RADS 2 or less would not undergo re-TURBT.
Incomplete resection was performed in 15 of the patients. When incomplete resection were excluded, 35 of the patients had complete resection, and the remaining 23 had residual disease, and complete resection would not have been performed in this patient. Since patients with VI-RADS 3 will continue in the current algorithm, 10 of the 30 patients with high risk non-MIBC patients would undergo re-TURBT.
In complete resection was performed in one of the patients. When in complete resections were excluded, six of the patients had complete resection and the remaining three had residual disease. Of the 75 patients with VI-RADS 4 and higher with high risk non-MIBC patients would not undergo re-TURBT. Incomplete resection was performed in four of the patients.
When incomplete resections were excluded, two of the patients would still have residual disease, and complete resection would not have been performed in these patients. Discussion. In our study, the contribution of the TURBT to upstaging VI-RADS 2 and less in the new VI-RADS-based algorithm could not be demonstrated. We think that re-TURBT should be continued in cases with VI-RADS 2 and less, which are at a higher risk for low-stage disease after primary resection.
In the new VI-RADS-based approach, patients with VI-RADS and higher can skip re-TURBT aimed at pathological conformation of the muscle invasion and undergo immediate radical treatment. In our study, VI-RADS 4 and higher lesions were considered muscle invasive, and the sensitivity was 77.8%, and the specificity was 99.4%.
PPV and NPV were 98.6% and 89.9% respectively. The possibility of predicting upstaging was limited. Conclusion. The new VI-RADS-based approach shows that re-TURBT can be skipped for upstaging. In our study, this was especially successful when VI-RADS 4 and higher prevented the patient from skipping stages by switching and radical treatment as soon as possible.
In cases with VI-RADS 2 and less, since the residual disease is high, even when incomplete resections are excluded, re-TURBT must be continued, just like cases with VI-RADS 3.
Merve Şam Özdemir: Patients and methods. The MRI was performed on a 3 Tesla MRI scanner using sequences according to the VI-RADS protocol. All examinations were reviewed by an experienced urogenital radiologist blinded to the clinical information. The reader also assigned a VI-RADS score to each lesion up to three per patient, and only the one with the highest VI-RADS score was considered for each patient.
All patients underwent conventional bipolar white light TURBT at our institution within six weeks of NP MRI. For all T1 patients, as well as patients with high risk TA deficient muscularis propria in the resection specimen, three TURBT was performed at the score site or initial rejection site by the same two experienced surgeons within two to six weeks after the initial surgery.
All tumor samples were analyzed by two experienced neuropathologists. In this study, data were analyzed by SPSS 22.0. ROC analysis was used to predict the success of NP MRI in distinguishing between non-MIBC and MIBC. The specificity, sensitivity, and negative positive predictive values were calculated for the MP MRI. The P value was accepted as less than 0.05 at a 95% confidence interval.
Results. A total of 283 patients underwent MP MRI before TURBT. The clinical characteristics and tumor characteristics of the entire population are summarized in table 1. VI-RADS and final pathologies of the patients were compared with in table 2. The performance of the MP MRI in distinguishing non-MIBC from MIBC tumors in 283 cases.
When VI-RADS 3 and higher lesions were considered muscle invasive, its sensitivity was 95.7%, and its specificity was 92.5. PPV and NPV were 86.6% and 97.7% respectively. When VI-RADS 4 and higher lesions were considered muscle invasive, the sensitivity was 77.8%, and the specificity was 99.4%.
PPV and NPV were 98.6% and 89.9% respectively. At baseline TURBT, 77 patients with MIBC, 80 with low risk non-MIBC, and 37 bit with carcinoma in-situ were excluded. A total of 89 patients were evaluated for the final analysis. Clinical and tumor characteristics of high risk non-MIBC patients are summarized in table 3. If the new VI-RADS-based approach was used, 73 of 178 high risk non-MIBC patients with VI-RADS 2 or less would not undergo re-TURBT.
Incomplete resection was performed in 15 of the patients. When incomplete resection were excluded, 35 of the patients had complete resection, and the remaining 23 had residual disease, and complete resection would not have been performed in this patient. Since patients with VI-RADS 3 will continue in the current algorithm, 10 of the 30 patients with high risk non-MIBC patients would undergo re-TURBT.
In complete resection was performed in one of the patients. When in complete resections were excluded, six of the patients had complete resection and the remaining three had residual disease. Of the 75 patients with VI-RADS 4 and higher with high risk non-MIBC patients would not undergo re-TURBT. Incomplete resection was performed in four of the patients.
When incomplete resections were excluded, two of the patients would still have residual disease, and complete resection would not have been performed in these patients. Discussion. In our study, the contribution of the TURBT to upstaging VI-RADS 2 and less in the new VI-RADS-based algorithm could not be demonstrated. We think that re-TURBT should be continued in cases with VI-RADS 2 and less, which are at a higher risk for low-stage disease after primary resection.
In the new VI-RADS-based approach, patients with VI-RADS and higher can skip re-TURBT aimed at pathological conformation of the muscle invasion and undergo immediate radical treatment. In our study, VI-RADS 4 and higher lesions were considered muscle invasive, and the sensitivity was 77.8%, and the specificity was 99.4%.
PPV and NPV were 98.6% and 89.9% respectively. The possibility of predicting upstaging was limited. Conclusion. The new VI-RADS-based approach shows that re-TURBT can be skipped for upstaging. In our study, this was especially successful when VI-RADS 4 and higher prevented the patient from skipping stages by switching and radical treatment as soon as possible.
In cases with VI-RADS 2 and less, since the residual disease is high, even when incomplete resections are excluded, re-TURBT must be continued, just like cases with VI-RADS 3.