Background

Vesical Imaging Reporting and Data System (VI-RADS) score is adopted to provide preoperative bladder cancer (BCa) staging. Repeated transurethral resection of bladder tumor (Re-TURBT) is recommended in most of high-risk non–muscle-invasive bladder cancers (HR-NMIBCs) due to possibility of persistent/understaged disease after initial TURBT. No diagnostic tools able to improve patient’s stratification for such recommendation exist.

Objective

To (1) prospectively validate VI-RADS for discriminating between NMIBC and muscle-invasive bladder cancer (MIBC) at TURBT, and (2) evaluate the accuracy of VI-RADS for identifying HR-NMIBC patients who could avoid Re-TURBT and detecting those at higher risk for understaging after TURBT.

Design, setting, and participants

Patients with BCa suspicion were offered multiparametric magnetic resonance imaging (mpMRI) before TURBT. According to VI-RADS, a cutoff of ≥3 to define MIBC was assumed. TURBT reports were compared with preoperative VI-RADS scores to assess accuracy of mpMRI for discriminating between NMIBC and MIBC. HR-NMIBC Re-TURBT reports were compared with preoperatively recorded VI-RADS scores to assess mpMRI accuracy in predicting Re-TURBT outcomes.

Intervention

Multiparametric MRI of the bladder before TURBT.

Outcome measurements and statistical analysis

Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were calculated for mpMRI performance in patients undergoing TURBT and for HR-NMIBC patients candidate for Re-TURBT. Performance of mpMRI was assessed by receiver operating characteristic curve analysis. Ƙ statistics was used to estimate inter- and intrareader variability.

Results and limitations

A total of 231 patients were enrolled. Multiparametric MRI showed sensitivity, specificity, PPV, and NPV for discriminating NMIBC from MIBC at initial TURBT of 91.9% (95% confidence interval [CI]: 82.2–97.3), 91.1% (95% CI: 85.8–94.9), 77.5% (95% CI: 65.8–86.7), and 97.1% (95% CI: 93.3–99.1), respectively. The area under the curve (AUC) was 0.94 (95% CI: 0.91–0.97). Among HR-NMIBC patients (n = 114), mpMRI before TURBT showed sensitivity, specificity, PPV, and NPV of 85% (95% CI: 62.1–96.8), 93.6% (95% CI: 86.6–97.6), 74.5% (95% CI: 52.4–90.1), and 96.6% (95% CI: 90.5–99.3) respectively, to identify patients with MIBC at Re-TURBT. The AUC was 0.93 (95% CI: 0.87–0.97).

Conclusions

VI-RADS is accurate for discriminating between NMIBC and MIBC. Within HR-NMIBC cases, VI-RADS could, in future, improve the selection of patients who are candidate for Re-TURBT.

Patient summary

We investigated the accuracy of Vesical Imaging Reporting and Data System (VI-RADS) score to asses bladder cancer staging before transurethral resection of bladder tumors, and we explored the performance of VI-RADS score as a future preoperative predictive tool for the selection of high-risk non–muscle-invasive bladder cancer patients who are candidate for undergoing early repeated transurethral resection of the primary tumor site.

中文翻译：

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血管成像报告和数据系统（VI-RADS）的前瞻性评估及其对高危非肌肉浸润性膀胱癌患者反复经尿道切除术的管理的临床影响。

背景

采用血管成像报告和数据系统（VI-RADS）评分来提供术前膀胱癌（BCa）分期。在大多数高危非肌肉浸润性膀胱癌（HR-NMIBC）中，建议对大多数高危非肌肉浸润性膀胱癌（HR-NMIBCs）行经尿道膀胱电切术（Re-TURBT），因为在初次TURBT后可能会持续/分期疾病。对于这种推荐，没有能够改善患者分层的诊断工具。

客观的

（1）前瞻性验证VI-RADS在TURBT时可区分NMIBC和肌肉浸润性膀胱癌（MIBC），以及（2）评估VI-RADS识别可避免Re-TURBT并检测的HR-NMIBC患者的准确性那些在TURBT之后分期付款风险较高的人。

设计，设置和参与者

在TURBT之前，对患有BCa怀疑的患者进行了多参数磁共振成像（mpMRI）。根据VI-RADS，假定MIBC的截止值≥3。将TURBT报告与术前VI-RADS得分进行比较，以评估mpMRI鉴别NMIBC和MIBC的准确性。将HR-NMIBC Re-TURBT报告与术前记录的VI-RADS得分进行比较，以评估mpMRI预测Re-TURBT结局的准确性。

干涉

TURBT前膀胱的多参数MRI。

成果测量和统计分析

计算了接受TURBT的患者和HR-NMIBC候选Re-TURBT的mpMRI表现的敏感性，特异性，阳性（PPV）和阴性（NPV）预测值。mpMRI的性能通过接收器工作特性曲线分析进行评估。Ƙ统计数据用于估计阅读器之间和阅读器内部的变异性。

结果与局限性

共有231名患者入组。多参数MRI显示在初始TURBT时区分NMIBC和MIBC的敏感性，特异性，PPV和NPV分别为91.9％（95％置信区间[CI]：82.2–97.3），91.1％（95％CI：85.8–94.9），77.5％ （95％CI：93.8–99.1）（95％CI：65.8–86.7）。曲线下面积（AUC）为0.94（95％CI：0.91-0.97）。在HR-NMIBC患者中（n  = 114），在TURBT之前的mpMRI显示敏感性，特异性，PPV和NPV分别为85％（95％CI：62.1–96.8），93.6％（95％CI：86.6–97.6），74.5％ （95％CI：52.4–90.1）和96.6％（95％CI：90.5–99.3），以在Re-TURBT时识别出MIBC患者。AUC为0.93（95％CI：0.87-0.97）。

结论

VI-RADS可以准确区分NMIBC和MIBC。在HR-NMIBC病例中，VI-RADS将来可以改善对Re-TURBT候选者的选择。

病人总结

我们调查了血管成像报告和数据系统（VI-RADS）评分在评估膀胱肿瘤经尿道电切术之前评估膀胱癌分期的准确性，并探讨了VI-RADS评分作为未来术前预测高发率的工具的性能。高危非肌肉浸润性膀胱癌患者，适合于早期重复经尿道原发肿瘤部位切除术。