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Panebianco V, Briganti A, Boellaard TN, Catto J, Comperat E, Efstathiou J, van der Heijden AG, Giannarini G, Girometti R, Mertens L, Takeuchi M, Muglia VF, Narumi Y, Novara G, Pecoraro M, Roupret M, Sanguedolce F, Santini D, Shariat SF, Simone G, Vargas HA, Woo S, Barentsz J, Witjes JA. Clinical application of bladder MRI and the Vesical Imaging-Reporting and Data System. Nat Rev Urol 2024; 21:243-251. [PMID: 38036666 DOI: 10.1038/s41585-023-00830-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 12/02/2023]
Abstract
Diagnostic work-up and risk stratification in patients with bladder cancer before and after treatment must be refined to optimize management and improve outcomes. MRI has been suggested as a non-invasive technique for bladder cancer staging and assessment of response to systemic therapy. The Vesical Imaging-Reporting And Data System (VI-RADS) was developed to standardize bladder MRI image acquisition, interpretation and reporting and enables accurate prediction of muscle-wall invasion of bladder cancer. MRI is available in many centres but is not yet recommended as a first-line test for bladder cancer owing to a lack of high-quality evidence. Consensus-based evidence on the use of MRI-VI-RADS for bladder cancer care is needed to serve as a benchmark for formulating guidelines and research agendas until further evidence from randomized trials becomes available.
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Affiliation(s)
- Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy.
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Thierry N Boellaard
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - James Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Eva Comperat
- Department of Pathology, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Hopital Tenon, Paris, France
| | - Jason Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Gianluca Giannarini
- Urology Unit, Academic Medical Centre "Santa Maria della Misericordia", Udine, Italy
| | - Rossano Girometti
- Institute of Radiology, Academic Medical Centre "Santa Maria della Misericordia", Udine, Italy
| | - Laura Mertens
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Valdair F Muglia
- Department of Medical Images, Radiation Therapy and Oncohematology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | | | - Giacomo Novara
- Department of Surgery, Oncology, and Gastroenterology - Urology Clinic, University of Padua, Padua, Italy
| | - Martina Pecoraro
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Morgan Roupret
- Department of Urology, Sorbonne University, AP-HP, Pitié Salpétrière Hospital, Paris, France
| | - Francesco Sanguedolce
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Daniele Santini
- Division of Medical Oncology A, Policlinico Umberto I, Rome, Italy
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
| | - Shahrokh F Shariat
- Department of Urology, Teaching Hospital Motol and 2nd Faculty of Medicine, Charles University Praha, Prague, Czech Republic
- Department of Urology, Comprehensive Cancer Center, Medical University Vienna, Vienna General Hospital, Vienna, Austria
| | - Giuseppe Simone
- IRCCS "Regina Elena" National Cancer Institute, Department of Urology, Rome, Italy
| | - Hebert A Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jelle Barentsz
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands
| | - J Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
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Ikuma S, Akatsuka J, Takeda H, Endo Y, Kiriyama T, Hamasaki T, Kimura G, Kondo Y. Determining the clinicopathological significance of the VI-RADS ≧4 group: a retrospective study. BMC Urol 2024; 24:63. [PMID: 38509503 PMCID: PMC10953073 DOI: 10.1186/s12894-024-01452-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 03/11/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND The Vesical Imaging Reporting and Data System (VI-RADS) is widely used for predicting muscle-invasive bladder cancer (MIBC). This study aimed to determine the clinicopathological significance of the VI-RADS ≧4 (VI≧4) group. METHODS Patients who underwent transurethral resections of bladder tumors during the study period and preoperative magnetic resonance imaging were considered. The patients were pathologically diagnosed with urothelial carcinoma (UC). We first compared the results of patients with VI-RADS scores of 3 and 4 to determine the cut-off score for MIBC; thereafter, the patients were divided into the VI≧4 and VI-RADS ≦3 (VI≦3) groups using VI-RADS. The clinicopathological significance of the VI≧4 group was examined retrospectively by comparing the characteristics of each group. RESULTS In total, 121 cases were examined, of which 28 were pathologically diagnosed with MIBC. Of the 28 MIBC cases, three (10.7%) had a VI-RADS score of ≦3, and 25 (89.3%) had a VI-RADS score of ≧4. Of the 93 NMIBC cases, 86 (92.5%) had a VI-RADS score of ≦3, and seven (7.5%) had a VI-RADS score of ≧4. The diagnostic performance of the VI-RADS with a cut-off score of 4 was 89.3% for sensitivity, 92.5% for specificity, and an area under the curve (AUC) of 0.91. Contrastingly, for a cut-off score of 3, the sensitivity was 89.3%, specificity was 62.0%, and AUC was 0.72. A VI-RADS score of ≥ 4 could predict MIBC. In the VI≧4 group, 30 of 32 (93.8%) patients had high-grade tumors. The VI≧4 group had significantly more high-grade bladder cancers than the VI≦3 group (p < 0.001 OR = 31.77 95%CI:8.47-1119.07). In addition, the VI≧4 group had more tumor necrosis (VI≧4 vs VI≦3, p < 0.001 OR = 7.46 95%CI:2.61-21.34) and more UC variant cases (VI≧4 vs VI≦3, p = 0.034 OR = 3.28 95%CI:1.05-10.25) than the VI≦3 group. CONCLUSIONS This study suggests that VI-RADS has a high diagnostic performance in predicting MIBC and that VI-RADS could diagnose high-grade tumors, necrosis, and UC variants.
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Affiliation(s)
- Shunsuke Ikuma
- Department of Urology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Jun Akatsuka
- Department of Urology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Hayato Takeda
- Department of Urology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Yuki Endo
- Department of Urology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Tomonari Kiriyama
- Department of Radiology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Tsutomu Hamasaki
- Department of Urology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Go Kimura
- Department of Urology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan
| | - Yukihiro Kondo
- Department of Urology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan.
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Fávero Prietto Dos Santos J, Ghezzi CLA, Pedrollo IM, Cruz ÍR, Orozco OFG, Zapparoli M, Schuch A, Muglia VF. Practical Guide to VI-RADS: MRI Protocols, Lesion Characterization, and Pitfalls. Radiographics 2024; 44:e230149. [PMID: 38421912 DOI: 10.1148/rg.230149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Urothelial carcinoma is the most common type of bladder cancer (BC), accounting for approximately 90% of all cases. Evaluating the depth of tumor invasion in the bladder wall (tumor staging) is essential for determining the treatment and prognosis in patients with BC. Neoadjuvant therapy followed by radical cystectomy is the most common treatment of localized muscle-invasive BC (MIBC). Therefore, it is vital to differentiate non-MIBC from MIBC. Transurethral resection of bladder tumor (TURBT) is the reference standard to determine the extent of tumor invasion into the bladder wall through tissue sampling. However, this diagnostic and therapeutic method may not adequately sample the muscularis propria, leading to a higher risk of residual disease, early recurrence, and tumor understaging in approximately 50% of patients during the initial TURBT. Multiparametric MRI can overcome some of the limitations of TURBT when evaluating BC, particularly regarding tumor staging. In this context, the Vesical Imaging Reporting and Data System (VI-RADS) classification was developed to establish standards for bladder multiparametric MRI and interpretation. It uses a 5-point scale to assess the likelihood of detrusor muscle invasion. T2-weighted MR images are particularly useful as an initial guide, especially for categories 1-3, while the presence of muscular invasion is determined with diffusion-weighted and dynamic contrast-enhanced sequences. Diffusion-weighted imaging takes precedence as the dominant method when optimal image quality is achieved. The presence of a stalk or a thickened inner layer and no evidence of interruption of the signal intensity of the muscular layer are central for predicting a low likelihood of muscle invasion. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material. See the invited commentary by Hoegger in this issue.
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Affiliation(s)
- Jônatas Fávero Prietto Dos Santos
- From the Department of Radiology, Division of Body Imaging, Hospital Moinhos de Vento, 910 Ramiro Barcelos St, Porto Alegre, RS 90035-000, Brazil, and Program in Pneumology Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (J.F.P.d.S.); Department of Radiology, Division of Abdominal Imaging, Hospital Moinhos de Vento, Porto Alegre, Brazil (C.L.A.G., I.M.P., A.S.); Department of Radiology, Division of Abdominal Imaging, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (C.L.A.G., I.M.P); Department of Radiology, Division of Abdominal Imaging, Hospital da Restauração, Recife, Brazil, Centro de Diagnóstico Boris Berenstein, Recife, Brazil, and Department of Radiology, Division of Abdominal Imaging, Hospital Santa Joana, Recife, Brazil (I.R.C.); Division of Abdominal Imaging, Diagnóstico Avançado por Imagem (DAPI), Curitiba, Brazil, and Department of Internal Medicine, Division of Abdominal Imaging, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil (O.F.G.O., M.Z.); and Department of Radiology, Oncology and Hematology, Division of Abdominal Imaging, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil (V.F.M.)
| | - Caroline Lorenzoni Almeida Ghezzi
- From the Department of Radiology, Division of Body Imaging, Hospital Moinhos de Vento, 910 Ramiro Barcelos St, Porto Alegre, RS 90035-000, Brazil, and Program in Pneumology Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (J.F.P.d.S.); Department of Radiology, Division of Abdominal Imaging, Hospital Moinhos de Vento, Porto Alegre, Brazil (C.L.A.G., I.M.P., A.S.); Department of Radiology, Division of Abdominal Imaging, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (C.L.A.G., I.M.P); Department of Radiology, Division of Abdominal Imaging, Hospital da Restauração, Recife, Brazil, Centro de Diagnóstico Boris Berenstein, Recife, Brazil, and Department of Radiology, Division of Abdominal Imaging, Hospital Santa Joana, Recife, Brazil (I.R.C.); Division of Abdominal Imaging, Diagnóstico Avançado por Imagem (DAPI), Curitiba, Brazil, and Department of Internal Medicine, Division of Abdominal Imaging, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil (O.F.G.O., M.Z.); and Department of Radiology, Oncology and Hematology, Division of Abdominal Imaging, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil (V.F.M.)
| | - Ivan Morzoletto Pedrollo
- From the Department of Radiology, Division of Body Imaging, Hospital Moinhos de Vento, 910 Ramiro Barcelos St, Porto Alegre, RS 90035-000, Brazil, and Program in Pneumology Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (J.F.P.d.S.); Department of Radiology, Division of Abdominal Imaging, Hospital Moinhos de Vento, Porto Alegre, Brazil (C.L.A.G., I.M.P., A.S.); Department of Radiology, Division of Abdominal Imaging, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (C.L.A.G., I.M.P); Department of Radiology, Division of Abdominal Imaging, Hospital da Restauração, Recife, Brazil, Centro de Diagnóstico Boris Berenstein, Recife, Brazil, and Department of Radiology, Division of Abdominal Imaging, Hospital Santa Joana, Recife, Brazil (I.R.C.); Division of Abdominal Imaging, Diagnóstico Avançado por Imagem (DAPI), Curitiba, Brazil, and Department of Internal Medicine, Division of Abdominal Imaging, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil (O.F.G.O., M.Z.); and Department of Radiology, Oncology and Hematology, Division of Abdominal Imaging, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil (V.F.M.)
| | - Ítalo Ribeiro Cruz
- From the Department of Radiology, Division of Body Imaging, Hospital Moinhos de Vento, 910 Ramiro Barcelos St, Porto Alegre, RS 90035-000, Brazil, and Program in Pneumology Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (J.F.P.d.S.); Department of Radiology, Division of Abdominal Imaging, Hospital Moinhos de Vento, Porto Alegre, Brazil (C.L.A.G., I.M.P., A.S.); Department of Radiology, Division of Abdominal Imaging, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (C.L.A.G., I.M.P); Department of Radiology, Division of Abdominal Imaging, Hospital da Restauração, Recife, Brazil, Centro de Diagnóstico Boris Berenstein, Recife, Brazil, and Department of Radiology, Division of Abdominal Imaging, Hospital Santa Joana, Recife, Brazil (I.R.C.); Division of Abdominal Imaging, Diagnóstico Avançado por Imagem (DAPI), Curitiba, Brazil, and Department of Internal Medicine, Division of Abdominal Imaging, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil (O.F.G.O., M.Z.); and Department of Radiology, Oncology and Hematology, Division of Abdominal Imaging, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil (V.F.M.)
| | - Oscar Fernando Ghattas Orozco
- From the Department of Radiology, Division of Body Imaging, Hospital Moinhos de Vento, 910 Ramiro Barcelos St, Porto Alegre, RS 90035-000, Brazil, and Program in Pneumology Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (J.F.P.d.S.); Department of Radiology, Division of Abdominal Imaging, Hospital Moinhos de Vento, Porto Alegre, Brazil (C.L.A.G., I.M.P., A.S.); Department of Radiology, Division of Abdominal Imaging, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (C.L.A.G., I.M.P); Department of Radiology, Division of Abdominal Imaging, Hospital da Restauração, Recife, Brazil, Centro de Diagnóstico Boris Berenstein, Recife, Brazil, and Department of Radiology, Division of Abdominal Imaging, Hospital Santa Joana, Recife, Brazil (I.R.C.); Division of Abdominal Imaging, Diagnóstico Avançado por Imagem (DAPI), Curitiba, Brazil, and Department of Internal Medicine, Division of Abdominal Imaging, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil (O.F.G.O., M.Z.); and Department of Radiology, Oncology and Hematology, Division of Abdominal Imaging, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil (V.F.M.)
| | - Maurício Zapparoli
- From the Department of Radiology, Division of Body Imaging, Hospital Moinhos de Vento, 910 Ramiro Barcelos St, Porto Alegre, RS 90035-000, Brazil, and Program in Pneumology Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (J.F.P.d.S.); Department of Radiology, Division of Abdominal Imaging, Hospital Moinhos de Vento, Porto Alegre, Brazil (C.L.A.G., I.M.P., A.S.); Department of Radiology, Division of Abdominal Imaging, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (C.L.A.G., I.M.P); Department of Radiology, Division of Abdominal Imaging, Hospital da Restauração, Recife, Brazil, Centro de Diagnóstico Boris Berenstein, Recife, Brazil, and Department of Radiology, Division of Abdominal Imaging, Hospital Santa Joana, Recife, Brazil (I.R.C.); Division of Abdominal Imaging, Diagnóstico Avançado por Imagem (DAPI), Curitiba, Brazil, and Department of Internal Medicine, Division of Abdominal Imaging, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil (O.F.G.O., M.Z.); and Department of Radiology, Oncology and Hematology, Division of Abdominal Imaging, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil (V.F.M.)
| | - Alice Schuch
- From the Department of Radiology, Division of Body Imaging, Hospital Moinhos de Vento, 910 Ramiro Barcelos St, Porto Alegre, RS 90035-000, Brazil, and Program in Pneumology Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (J.F.P.d.S.); Department of Radiology, Division of Abdominal Imaging, Hospital Moinhos de Vento, Porto Alegre, Brazil (C.L.A.G., I.M.P., A.S.); Department of Radiology, Division of Abdominal Imaging, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (C.L.A.G., I.M.P); Department of Radiology, Division of Abdominal Imaging, Hospital da Restauração, Recife, Brazil, Centro de Diagnóstico Boris Berenstein, Recife, Brazil, and Department of Radiology, Division of Abdominal Imaging, Hospital Santa Joana, Recife, Brazil (I.R.C.); Division of Abdominal Imaging, Diagnóstico Avançado por Imagem (DAPI), Curitiba, Brazil, and Department of Internal Medicine, Division of Abdominal Imaging, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil (O.F.G.O., M.Z.); and Department of Radiology, Oncology and Hematology, Division of Abdominal Imaging, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil (V.F.M.)
| | - Valdair Francisco Muglia
- From the Department of Radiology, Division of Body Imaging, Hospital Moinhos de Vento, 910 Ramiro Barcelos St, Porto Alegre, RS 90035-000, Brazil, and Program in Pneumology Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (J.F.P.d.S.); Department of Radiology, Division of Abdominal Imaging, Hospital Moinhos de Vento, Porto Alegre, Brazil (C.L.A.G., I.M.P., A.S.); Department of Radiology, Division of Abdominal Imaging, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (C.L.A.G., I.M.P); Department of Radiology, Division of Abdominal Imaging, Hospital da Restauração, Recife, Brazil, Centro de Diagnóstico Boris Berenstein, Recife, Brazil, and Department of Radiology, Division of Abdominal Imaging, Hospital Santa Joana, Recife, Brazil (I.R.C.); Division of Abdominal Imaging, Diagnóstico Avançado por Imagem (DAPI), Curitiba, Brazil, and Department of Internal Medicine, Division of Abdominal Imaging, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil (O.F.G.O., M.Z.); and Department of Radiology, Oncology and Hematology, Division of Abdominal Imaging, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil (V.F.M.)
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Kong L, Wen Z, Cai Q, Lin Y, Chen Y, Cao W, Li M, Qian L, Chen J, Guo Y, Wang H. Amide Proton Transfer-Weighted MRI and Diffusion-Weighted Imaging in Bladder Cancer: A Complementary Tool to the VI-RADS. Acad Radiol 2024; 31:564-571. [PMID: 37821347 DOI: 10.1016/j.acra.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/27/2023] [Accepted: 09/03/2023] [Indexed: 10/13/2023]
Abstract
RATIONALE AND OBJECTIVES To investigate the feasibility of amide proton transfer-weighted (APTw) and diffusion-weighted Magnetic Resonance Imaging (MRI) as a means by which to add value to the Vesical Imaging Reporting and Data System (VI-RADS) for discriminating muscle invasive bladder cancer (MIBC) from nonmuscle invasive bladder cancer (NMIBC). MATERIALS AND METHODS This prospective study enrolled participants with pathologically confirmed bladder cancer (BCa) who underwent preoperative multiparametric MRI, including APTw and diffusion-weighted MRI, from July 2020 to January 2023. The exclusion criteria were lesions smaller than 10 mm, missing smooth muscle layer in the operation specimen, neoadjuvant therapy before MRI, inadequate image quality, and malignancy other than urothelial neoplasm. Two radiologists independently assigned the VI-RADS score for each participant. Quantitative parameters derived from APTw and diffusion-weighted MRI were obtained by another two radiologists. Receiver operating characteristic (ROC) curve analysis with the area under the ROC curve (AUC) was performed to evaluate the diagnostic performances of quantitative parameters for discriminating BCa detrusor muscle invasion status. RESULTS A total of 106 participants were enrolled (mean age, 64 ± 12 years [SD]; 90 men): 32 with MIBC and 74 with NMIBC. Lower apparent diffusion coefficient (ADC) values (0.88 × 10-3 mm2/s ± 0.12 vs. 1.08 × 10-3 mm2/s ± 0.25; P < 0.001) and higher APTw values (6.89% [interquartile range {IQR}, 5.05%-12.17%] vs. 3.61% [IQR, 2.23%-6.83%]; P < 0.001) were observed in the MIBC group. Compared to VI-RADS alone, both APTw (P = 0.003) and ADC (P = 0.020) values could improve the diagnostic performance of VI-RADS in differentiating MIBC from NMIBC. The combination of the three yielded the highest diagnostic performance (AUC, 0.93; 95% CI:0.87,0.97) for evaluating muscle invasion status. The addition of the APTw values to the combination of VI-RADS and ADC values notably improved the diagnostic performance for differentiating NMIBC from MIBC (VI-RADS+ADC vs. VI-RADS+APTw+ADC, P = 0.046). CONCLUSION MRI parameters derived from APTw and diffusion-weighted MRI can be used to accurately assess muscle invasion status in BCa and provide additional value to VI-RADS.
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Affiliation(s)
- Lingmin Kong
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, PR China (L.K., Z.W., Q.C., Y.L., Y.C., W.C., M.L., Y.G., H.W.)
| | - Zhihua Wen
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, PR China (L.K., Z.W., Q.C., Y.L., Y.C., W.C., M.L., Y.G., H.W.)
| | - Qian Cai
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, PR China (L.K., Z.W., Q.C., Y.L., Y.C., W.C., M.L., Y.G., H.W.)
| | - Yingyu Lin
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, PR China (L.K., Z.W., Q.C., Y.L., Y.C., W.C., M.L., Y.G., H.W.)
| | - Yanling Chen
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, PR China (L.K., Z.W., Q.C., Y.L., Y.C., W.C., M.L., Y.G., H.W.)
| | - Wenxin Cao
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, PR China (L.K., Z.W., Q.C., Y.L., Y.C., W.C., M.L., Y.G., H.W.)
| | - Meiqin Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, PR China (L.K., Z.W., Q.C., Y.L., Y.C., W.C., M.L., Y.G., H.W.)
| | - Long Qian
- MR Research, GE Healthcare, Beijing, China (L.Q.)
| | - Junxing Chen
- Department of Urology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, PR China (J.C.)
| | - Yan Guo
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, PR China (L.K., Z.W., Q.C., Y.L., Y.C., W.C., M.L., Y.G., H.W.)
| | - Huanjun Wang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, PR China (L.K., Z.W., Q.C., Y.L., Y.C., W.C., M.L., Y.G., H.W.).
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Parillo M, Mallio CA, Van der Molen AJ, Rovira À, Dekkers IA, Karst U, Stroomberg G, Clement O, Gianolio E, Nederveen AJ, Radbruch A, Quattrocchi CC. The role of gadolinium-based contrast agents in magnetic resonance imaging structured reporting and data systems (RADS). MAGMA 2024; 37:15-25. [PMID: 37702845 PMCID: PMC10876744 DOI: 10.1007/s10334-023-01113-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/22/2023] [Accepted: 07/13/2023] [Indexed: 09/14/2023]
Abstract
Among the 28 reporting and data systems (RADS) available in the literature, we identified 15 RADS that can be used in Magnetic Resonance Imaging (MRI). Performing examinations without using gadolinium-based contrast agents (GBCA) has benefits, but GBCA administration is often required to achieve an early and accurate diagnosis. The aim of the present review is to summarize the current role of GBCA in MRI RADS. This overview suggests that GBCA are today required in most of the current RADS and are expected to be used in most MRIs performed in patients with cancer. Dynamic contrast enhancement is required for correct scores calculation in PI-RADS and VI-RADS, although scientific evidence may lead in the future to avoid the GBCA administration in these two RADS. In Bone-RADS, contrast enhancement can be required to classify an aggressive lesion. In RADS scoring on whole body-MRI datasets (MET-RADS-P, MY-RADS and ONCO-RADS), in NS-RADS and in Node-RADS, GBCA administration is optional thanks to the intrinsic high contrast resolution of MRI. Future studies are needed to evaluate the impact of the high T1 relaxivity GBCA on the assignment of RADS scores.
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Affiliation(s)
- Marco Parillo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Carlo Augusto Mallio
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
- Research Unit of Diagnostic Imaging and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Aart J Van der Molen
- Department of Radiology, C-2S, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Àlex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ilona A Dekkers
- Department of Radiology, C-2S, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Uwe Karst
- Institute of Inorganic and Analytical Chemistry, University of Münster, Corrensstr. 48, 48149, Münster, Germany
| | - Gerard Stroomberg
- RIWA-Rijn-Association of River Water Works, Groenendael 6, 3439 LV, Nieuwegein, The Netherlands
| | - Olivier Clement
- Service de Radiologie, Université de Paris, AP-HP, Hôpital Européen Georges Pompidou, DMU Imagina, 20 Rue LeBlanc, 75015, Paris, France
| | - Eliana Gianolio
- Department of Molecular Biotechnologies and Health Science, University of Turin, Via Nizza 52, 10125, Turin, Italy
| | - Aart J Nederveen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Alexander Radbruch
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127, Bonn, Germany
| | - Carlo Cosimo Quattrocchi
- Centre for Medical Sciences-CISMed, University of Trento, Via S. Maria Maddalena 1, 38122, Trento, Italy.
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Messina E, Proietti F, Laschena L, Flammia RS, Pecoraro M, Cipollari S, Simone G, Catalano C, Leonardo C, Panebianco V. MRI for risk stratification of muscle invasion by upper tract urothelial carcinoma: a feasibility study. Eur Radiol Exp 2024; 8:9. [PMID: 38238523 PMCID: PMC10796856 DOI: 10.1186/s41747-023-00403-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/03/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is recommended in patients with upper tract urothelial carcinoma (UTUC) only when computed tomography (CT) is contraindicated. However, CT does not allow distinguishing ureter wall layers, making impossible to assess muscle invasion, a factor contributing to differentiate high- from low-risk UTUCs, which require different therapeutic approaches. We investigated the feasibility of MRI assessment of UTUC muscle invasion. METHODS From June 2022 to March 2023, we prospectively enrolled patients suspected of UTUC, i.e., with positive urinary tract ultrasound and/or ureteroscopy, or positive urinary cytology and/or hematuria but negative cystoscopy and bladder ultrasound at two Italian centers. They underwent CT followed by MRI (≤ 24 h apart), independently reported by two experienced radiologists, blinded from histopathology results. After imaging confirmation, they all underwent nephroureterectomy and histopathology analysis. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and area under the receiver operating characteristic curve (AUC) were calculated. RESULTS Thirty-nine lesions were detected in 30 patients on both CT and MRI. Muscle-invasive UTUC prevalence was 81% (21/26) among patients with MRI suspicion and 8% (1/13) among those without MRI suspicion (p < 0.001). Considering the assessment of muscle-layer invasion, the more experienced reader achieved 95% sensitivity (95% confidence interval 82-100), 71% specificity (47-88), 81% PPV (63-93), 92% NPV (70-100), 85% accuracy (67-96), and 0.84 AUC (0.70-0.98). Inter-reader agreement was substantial (κ = 0.73). CONCLUSIONS MRI showed a promising diagnostic performance for the assessment of UTUC risk of muscle invasion. RELEVANCE STATEMENT Resulting feasible both in technical and clinical terms, MRI could be helpful for upper tract urothelial carcinomas pre-operative risk stratification, to allow a personalized patients' management. These results play in favor of promoting preoperative MRI for UTUC, as already proven for bladder cancer. KEY POINTS • Muscle invasion is a crucial information for tailored treatments of upper tract urothelial carcinomas. • CT does not distinguish ureter wall layers, making muscle invasion risk assessment not feasible. • MRI was shown to reliably diagnose muscle-layer invasion by upper tract urothelial carcinomas (sensitivity 95%, specificity 71%).
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Affiliation(s)
- Emanuele Messina
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale del Policlinico 155, Rome, 00185, Italy
| | - Flavia Proietti
- Department of Maternal-Infant and Urological Sciences, Sapienza University/Policlinico Umberto I, Viale del Policlinico 155, Rome, 00185, Italy
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Ludovica Laschena
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale del Policlinico 155, Rome, 00185, Italy
| | - Rocco Simone Flammia
- Department of Maternal-Infant and Urological Sciences, Sapienza University/Policlinico Umberto I, Viale del Policlinico 155, Rome, 00185, Italy
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Martina Pecoraro
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale del Policlinico 155, Rome, 00185, Italy
| | - Stefano Cipollari
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale del Policlinico 155, Rome, 00185, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Carlo Catalano
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale del Policlinico 155, Rome, 00185, Italy
| | - Costantino Leonardo
- Department of Maternal-Infant and Urological Sciences, Sapienza University/Policlinico Umberto I, Viale del Policlinico 155, Rome, 00185, Italy
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale del Policlinico 155, Rome, 00185, Italy.
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, Rome, 00161, Italy.
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Arita Y, Kwee TC, Woo S, Shigeta K, Ishii R, Okawara N, Edo H, Waseda Y, Vargas HA. Biparametric versus Multiparametric Magnetic Resonance Imaging for Assessing Muscle Invasion in Bladder Urothelial Carcinoma with Variant Histology Using the Vesical Imaging-Reporting and Data System. Eur Urol Focus 2024; 10:131-138. [PMID: 37633790 DOI: 10.1016/j.euf.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/27/2023] [Accepted: 08/11/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND The diagnostic performance of contrast medium-free biparametric magnetic resonance imaging (bpMRI; combining T2-weighted imaging [T2WI] and diffusion-weighted imaging [DWI]) for evaluating variant-histology urothelial carcinoma (VUC) remains unknown. OBJECTIVE To compare the diagnostic performance of bpMRI and multiparametric MRI (mpMRI; combining T2WI, DWI, and dynamic contrast-enhanced MRI]) for assessing muscle invasion of VUC. DESIGN, SETTING, AND PARTICIPANTS This multi-institution retrospective analysis included 118 patients with pathologically verified VUC who underwent bladder mpMRI before transurethral bladder tumor resection between 2010 and 2019. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Three board-certified radiologists separately evaluated two sets of images, set 1 (bpMRI) and set 2 (mpMRI), in accordance with the Vesical Imaging Reporting and Data System (VI-RADS). The histopathology results were utilized as a reference standard. Receiver operating characteristic curve analysis, Z test, and Wald test were used to assess diagnostic abilities. RESULTS AND LIMITATIONS Sixty-six (55.9%) and 52 (44.1%) of the 118 patients with VUC included in the analysis (mean age, 71 ± 10 yr; 88 men) had muscle-invasive bladder cancer (MIBC) and non-MIBC, respectively. For the diagnosis of MIBC, the areas under the curve for bpMRI were significantly smaller than those for mpMRI (0.870-0.884 vs 0.902-0.923, p < 0.05). The sensitivity of bpMRI was significantly lower than that of mpMRI for all readers with a VI-RADS cutoff score of 4 (65.2-66.7% vs 77.3-80.3%, p < 0.05). The specificity of bpMRI and mpMRI did not differ significantly for all readers (88.5-90.4 vs 88.5-92.3, p > 0.05). A limitation of the study is the limited sample size because of the rarity of VUC. CONCLUSIONS In patients with VUC, on applying VI-RADS, the diagnostic results of bpMRI were inferior to those of mpMRI for evaluating muscle invasion. Therefore, mpMRI-based methods are recommended for evaluating muscle invasiveness of VUC. PATIENT SUMMARY Contrast medium-free biparametric magnetic resonance imaging (bpMRI)-based Vesical Imaging Reporting and Data System (VI-RADS) can accurately diagnose pure urothelial carcinomas, similar to conventional multiparametric magnetic resonance imaging-based VI-RADS. However, bpMRI-based VI-RADS may misdiagnose muscle invasiveness of urothelial carcinoma with variant histology, particularly when its cutoff score is 4.
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Affiliation(s)
- Yuki Arita
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Radiology, Keio University School of Medicine, Tokyo, Japan.
| | - Thomas C Kwee
- Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
| | - Sungmin Woo
- Department of Radiology, NYU Langone Health, New York, NY, USA
| | - Keisuke Shigeta
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Ryota Ishii
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Naoko Okawara
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Hiromi Edo
- Department of Radiology, National Defence Medical College, Saitama, Japan
| | - Yuma Waseda
- Department of Urology, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
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Kazan O, Gunduz N, Bakir B, Iplikci A, Culpan M, Ersoy B, Yildirim A. Diagnostic validity of the vesical imaging-reporting and data system (VI-RADS): a real-world study. Actas Urol Esp 2023; 47:638-644. [PMID: 37209783 DOI: 10.1016/j.acuroe.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/05/2023] [Accepted: 04/13/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVES Preoperative Vesical Imaging-Reporting and Data System (VI-RADS) becomes widespread. We aimed to validate the diagnostic performance of VI-RADS in differentiating muscle-invasive (MIBC) from non-muscle-invasive bladder cancer (NMIBC) in a real-world setting. METHODS Between December 2019 and February 2022 suspected primary bladder cancer patients were reviewed. Those with proper multiparametric MRI (mpMRI) protocol for VI-RADS before any invasive treatment were included. Patients were locally staged according to transurethral resection, second resection, or radical cystectomy as the reference standard. Two experienced genitourinary radiologists who were blinded to clinical and histopathological data evaluated the mpMRI images independently and retrospectively. The diagnostic performance of both radiologists and the interreader agreement were analyzed. RESULTS Among 96 patients, 20 (20.8%) had MIBC, and 76 (79.2%) had NMIBC. Both radiologists had great diagnostic performance in diagnosing MIBC. The first radiologist had an area under curve (AUC) of 0.83 and 0.84, the sensitivity of 85% and 80%, and the specificity of 80.3% and 88.2% for VI-RADS ≥3 and ≥4, respectively. The second radiologist had an area under curve (AUC) of 0.79 and 0.77, the sensitivity of 85% and 65%, and the specificity of 73.7% and 89.5% for VI-RADS ≥3 and ≥4, respectively. The overall VI-RADS score agreement between the two radiologists was moderate (κ = 0.45). CONCLUSION VI-RADS is diagnostically powerful in differentiating MIBC from NMBIC prior to transurethral resection. The agreement between radiologists is moderate.
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Affiliation(s)
- O Kazan
- Servicio de Urología, Universidad Medeniyet de Estambul, Escuela de Medicina, Estambul, Turkey.
| | - N Gunduz
- Servicio de Radiología, Universidad Medeniyet de Estambul, Escuela de Medicina, Estambul, Turkey
| | - B Bakir
- Servicio de Radiología, Universidad de Estambul, Escuela de Medicina de Estambul, Estambul, Turkey
| | - A Iplikci
- Servicio de Urología, Universidad Medeniyet de Estambul, Escuela de Medicina, Estambul, Turkey
| | - M Culpan
- Servicio de Urología, Universidad Medeniyet de Estambul, Escuela de Medicina, Estambul, Turkey
| | - B Ersoy
- Servicio de Radiología, Universidad de Estambul, Escuela de Medicina de Estambul, Estambul, Turkey
| | - A Yildirim
- Servicio de Urología, Universidad Medeniyet de Estambul, Escuela de Medicina, Estambul, Turkey
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Ahn H, Kim TM, Hwang SI, Lee HJ, Choe G, Hong SK, Byun SS, Oh JJ. Tumor contact length with bladder wall provides effective risk stratification for lesions with a VIRADS score of 2-3. Eur Radiol 2023; 33:8417-8425. [PMID: 37438641 DOI: 10.1007/s00330-023-09925-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/17/2023] [Accepted: 05/14/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVES To evaluate the diagnostic performance of the tumor contact length (TCL) in the prediction of MIBC (muscle-invasive bladder cancer) in lesions corresponding to the vesical imaging-reporting and data system (VIRADS) score 2-3. METHODS This is a single institution, retrospective study targeting 191 consecutive patients assigned of VIRADS score 2-3, who had pre-transurethral resection MRI from July 2019 to September 2021. Logistic regression analyses were performed to determine meaningful predictors of MIBC for this score group, and a nomogram was plotted with those variables. The diagnostic performance of each predictor was compared at predefined thresholds (VIRADS score 3 and TCL 3 cm) using the generalized linear model and ROC analysis. RESULTS Both VIRADS score and TCL remained independent predictors of MIBC for this score group (odds ratio 7.3 for VIRADS score, and 1.3 for TCL, p < 0.01 for both). The contribution of TCL to the probability of MIBC in the nomogram was greater than that of the VIRADS score. VIRADS score had a sensitivity of 0.54 (14/26), specificity of 0.92 (203/221), and diagnostic accuracy of 0.88 (217/247), and TCL showed a sensitivity of 0.89 (23/26), specificity of 0.95 (209/221), and diagnostic accuracy of 0.94 (232/247). The difference in sensitivity (p = 0.03) and accuracy (p = 0.04) was statistically significant. The AUC was also significantly wider for TCL than for VIRADS (0.97 vs. 0.73, p < 0.01). CONCLUSION A simple index, TCL, may be helpful in further risk stratification for MIBC in patients with a score of VIRADS 2-3. CLINICAL RELEVANCE STATEMENT For bladder cancer patients with insufficient qualitative evidence of muscle layer invasion using VIRADS categorization, TCL, a simple quantitative indicator defined as the curvilinear contact length between the bladder wall and the tumor, may be helpful in risk stratification. KEY POINTS • Even when only lesions with score 2-3 were targeted, VIRADS was still a meaningful indicator of MIBC. • With a predefined threshold of 3 cm applied, TCL outperformed VIRADS in the score 2-3 group, in predicting MIBC. • A longer TCL for a lesion with a VIRADS score 2 may warrant an additional warning for MIBC, whereas a shorter TCL for a lesion with a score 3 may indicate a lower risk of MIBC.
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Affiliation(s)
- Hyungwoo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Taek Min Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Sung Il Hwang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hak Jong Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Gheeyoung Choe
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung Kyu Hong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong Jin Oh
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
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Woo S, Becker AS, Das JP, Ghafoor S, Arita Y, Benfante N, Gangai N, Teo MY, Goh AC, Vargas HA. Evaluating residual tumor after neoadjuvant chemotherapy for muscle-invasive urothelial bladder cancer: diagnostic performance and outcomes using biparametric vs. multiparametric MRI. Cancer Imaging 2023; 23:110. [PMID: 37964386 PMCID: PMC10644594 DOI: 10.1186/s40644-023-00632-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 11/03/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Neoadjuvant chemotherapy (NAC) before radical cystectomy is standard of care in patients with muscle-invasive bladder cancer (MIBC). Response assessment after NAC is important but suboptimal using CT. We assessed MRI without vs. with intravenous contrast (biparametric [BP] vs. multiparametric [MP]) for identifying residual disease on cystectomy and explored its prognostic role. METHODS Consecutive MIBC patients that underwent NAC, MRI, and cystectomy between January 2000-November 2022 were identified. Two radiologists reviewed BP-MRI (T2 + DWI) and MP-MRI (T2 + DWI + DCE) for residual tumor. Diagnostic performances were compared using receiver operating characteristic curve analysis. Kaplan-Meier curves and Cox proportional-hazards models were used to evaluate association with disease-free survival (DFS). RESULTS 61 patients (36 men and 25 women; median age 65 years, interquartile range 59-72) were included. After NAC, no residual disease was detected on pathology in 19 (31.1%) patients. BP-MRI was more accurate than MP-MRI for detecting residual disease after NAC: area under the curve = 0.75 (95% confidence interval (CI), 0.62-0.85) vs. 0.58 (95% CI, 0.45-0.70; p = 0.043). Sensitivity were identical (65.1%; 95% CI, 49.1-79.0) but specificity was higher in BP-MRI compared with MP-MRI for determining residual disease: 77.8% (95% CI, 52.4-93.6) vs. 38.9% (95% CI, 17.3-64.3), respectively. Positive BP-MRI and residual disease on pathology were both associated with worse DFS: hazard ratio (HR) = 4.01 (95% CI, 1.70-9.46; p = 0.002) and HR = 5.13 (95% CI, 2.66-17.13; p = 0.008), respectively. Concordance between MRI and pathology results was significantly associated with DFS. Concordant positive (MRI+/pathology+) patients showed worse DFS than concordant negative (MRI-/pathology-) patients (HR = 8.75, 95% CI, 2.02-37.82; p = 0.004) and compared to the discordant group (MRI+/pathology- or MRI-/pathology+) with HR = 3.48 (95% CI, 1.39-8.71; p = 0.014). CONCLUSION BP-MRI was more accurate than MP-MRI for identifying residual disease after NAC. A negative BP-MRI was associated with better outcomes, providing complementary information to pathological assessment of cystectomy specimens.
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Affiliation(s)
- Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
- Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016, USA.
| | - Anton S Becker
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
- Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016, USA
| | - Jeeban P Das
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Soleen Ghafoor
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, Zürich, CH-8091, Switzerland
| | - Yuki Arita
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Nicole Benfante
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Natalie Gangai
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Min Yuen Teo
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Alvin C Goh
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Hebert A Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
- Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016, USA
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11
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Jai-Ua C, Limpaiboon C, Siriboonrid S, Binsri N, Kanjanatarayon S, Wiriyabanditkul W, Jiraanankul V. Accuracy of Vesical Imaging-Reporting and Data System for muscle-invasive bladder cancer detection from multiparametric magnetic resonance imaging. Investig Clin Urol 2023; 64:546-553. [PMID: 37932565 PMCID: PMC10630688 DOI: 10.4111/icu.20230120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/15/2023] [Accepted: 09/07/2023] [Indexed: 11/08/2023] Open
Abstract
PURPOSE The Vesical Imaging-Reporting and Data System (VI-RADS) was used to distinguish the invasive nature of bladder masses before surgery. These imaging criteria can be used to carefully select patients who are candidates for repeat transurethral resection of bladder tumor (Re-TUR-BT). One-third of patients are understage at the time of Re-TUR-BT. This study aimed to evaluate the discrimination accuracy of VI-RADS between non-muscle-invasive bladder cancer and muscle-invasive bladder cancer. MATERIALS AND METHODS Patients with a bladder mass identified by cystoscopy who were assigned for TUR-BT were offered multiparametric magnetic resonance imaging (mpMRI) for VI-RADS. TUR-BT reports were compared with preoperative VI-RADS scores to evaluate the accuracy of discrimination of the muscle-invasive nature of the bladder mass. RESULTS A total of 58 bladder tumor lesions were included, 13 with muscle-invasive bladder cancer and 45 with non-muscle-invasive bladder cancer. Sensitivity and specificity were 92.3% and 86.7%, respectively, when a VI-RADS cutoff of 4 or more was used to define muscle-invasive bladder cancer. Positive predictive value and negative predictive value were 66.7% and 97.5%, with an accuracy of 87.9%. The area under the receiver operating characteristic curve was 0.932 (95% confidence interval, 0.874-0.989), and the empirical optimal cutpoint from the Youden method was 3. CONCLUSIONS VI-RADS is an accurate tool for correctly differentiating muscle-invasive bladder cancer from non-muscle-invasive bladder cancer. We found a cutpoint of VI-RADS 1-3 vs. 4-5 to have the highest specificity and accuracy for the discrimination of non-muscle-invasive from muscle-invasive bladder cancer.
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Affiliation(s)
- Chayanon Jai-Ua
- Division of Urology, Department of Surgery, Phramongkutklao Hospital, Bangkok, Thailand
| | | | - Satit Siriboonrid
- Division of Urology, Department of Surgery, Phramongkutklao Hospital, Bangkok, Thailand
| | - Nattapong Binsri
- Division of Urology, Department of Surgery, Phramongkutklao Hospital, Bangkok, Thailand
| | | | | | - Vittaya Jiraanankul
- Division of Urology, Department of Surgery, Phramongkutklao Hospital, Bangkok, Thailand.
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Li B, Li X, Li Z, Yang P, Pan C, Tian L, Xie C. Magnetic resonance radiographic features which might lead to misdiagnosis of muscle-invasive bladder cancer based on vesical imaging reporting and data system: the application experience of a single center. Quant Imaging Med Surg 2023; 13:7258-7268. [PMID: 37869292 PMCID: PMC10585496 DOI: 10.21037/qims-23-356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/24/2023] [Indexed: 10/24/2023]
Abstract
Background The Vesical Imaging Reporting and Data System (VI-RADS) has been widely used for diagnosing muscle-invasive bladder cancer (MIBC), yet instances of misdiagnosis persist. However, limited research discusses the factors affecting its accuracy. This study aimed to evaluate the diagnostic efficacy of the VI-RADS in our center and to preliminarily identify possible magnetic resonance imaging (MRI) characteristics of misdiagnosis. Methods From January 2018 to February 2023, a consecutive series of 211 participants pathologically diagnosed with bladder cancer (BC) who underwent an MRI exam were retrospectively enrolled. MRI was interpreted by 2 radiologists with different levels of experience, the diagnostic performance was validated using the receiver operating characteristic (ROC) curve, and VI-RADS ≥4 was considered to indicate MIBC-positive status. The clinical and radiographic characteristics of the true-positive (TP), true-negative (TN), false-positive (FP), and false-negative (FN) groups were analyzed using Kruskal-Wallis test or Fisher exact test. Results With VI-RADS ≥4 as the cutoff value, the area under the ROC curves (AUCs) were 0.951 (0.912-0.976) and 0.847 (0.791-0.893) for the more-experienced reader and less-experienced reader, respectively, with good interobserver agreement (κ=0.74105). The median tumor size in the TP (more experienced: 57 cases; less experienced: 44 cases) and FP (more experienced: 8 cases; less experienced: 9 cases) groups was larger than that in the TN (more experienced: 141 cases; less experienced: 139 cases) group for the more-experienced reader (TP: 28 mm; FP: 31 mm; TN: 19 mm; P<0.001 and P=0.031, respectively) and the less-experienced reader (TP: 31 mm; FP: 28 mm; TN: 19 mm; P<0.001 and P=0.042, respectively). The tumor base in the TP and FP groups was larger than that in the TN group for the more-experienced reader (TP: 37 mm; FP: 48 mm; TN: 15 mm; both P<0.001) and for the less-experienced reader (FP: 42 mm; FP: 36 mm; TN: 15 mm; P<0.001 and P=0.022, respectively). The median tumor base in the TP group was larger than that in the FN group for the less-experienced reader (TP: 42 mm; FN: 17 mm; P=0.004). Conclusions We observed good to excellent AUCs with good interobserver agreement among radiologists with different levels of expertise using VI-RADS. Large tumor size and wide tumor base affected the accuracy of VI-RADS in MIBC diagnosis.
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Affiliation(s)
- Boya Li
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xiangdong Li
- Department of Urology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zhiyong Li
- Department of Urology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Ping Yang
- Department of Pathology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Chenghao Pan
- School of Public Health, Sun Yat-sen University, Guangzhou, China
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Tian
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Chuanmiao Xie
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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Panebianco V. VI-RADS for the diagnosis and management of urinary bladder cancer. Eur Radiol 2023; 33:7209-7211. [PMID: 37106110 DOI: 10.1007/s00330-023-09677-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/07/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023]
Affiliation(s)
- Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy.
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14
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Islam NU, Jehangir M, Parry AH, Nazir SS, Bilal S. Diagnostic performance of multiparametric MRI based Vesical Imaging-Reporting and Data System (VI-RADS) scoring in discriminating between non-muscle invasive and muscle invasive bladder cancer. Pol J Radiol 2023; 88:e356-e364. [PMID: 37701172 PMCID: PMC10493860 DOI: 10.5114/pjr.2023.130807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/30/2023] [Indexed: 09/14/2023] Open
Abstract
Purpose The purpose of the present study was to assess the diagnostic accuracy of the Vesical Imaging-Reporting and Data System (VI-RADS) scoring system in predicting muscle infiltration of bladder cancer (BC) on a pre-operative multiparametric magnetic resonance imaging (mpMRI). Methods The prospective study enrolled patients with bladder lesions detected on a preliminary ultrasonography or cystoscopy. The patients underwent mpMRI on a 3T MRI scanner followed by surgery within 2 weeks. The tumours were assigned a VI-RADS score by 2 experienced abdominal radiologists. The VI-RADS score was compared with postoperative histopathological findings to confirm detrusor muscle infiltration. The diagnostic performance of VI-RADS for predicting muscle invasion was assessed by calculating sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy. Results A total of 60 patients were included in the study with a male: female ratio of 4.4 : 1. Transurethral resection of bladder tumour (TURBT) was performed in 47 (78.4%) and radical cystectomy in 13 (21.6%) patients. 19 (31.7%) had non-muscle invasive invasive BC (NMIBCa) and 41 (68.3%) had muscle invasive BC (MIBCa) on histopathology. There was a significant association between VI-RADS score and its components with muscle invasion (p < 0.05). A VI-RADS score of ≥ 3 had a sensitivity of 97.56% (95% CI: 0.87-0.99%), specificity of 73.68% (95% CI: 0.49-0.91), positive predictive value of 88.9% (95% CI: 0.79-0.94), negative predictive value of 93.33% (95% CI: 0.66-0.99), and diagnostic accuracy of 90% (95% CI: 0.80-0.96) for prediction of muscle invasion. Conclusion VI-RADS scoring system pre-operatively predicts the likelihood of muscle invasion in BC with a satisfactory diagnostic performance, and it should be incorporated in the diagnostic work-up of BC patients.
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Affiliation(s)
- Naseer ul Islam
- Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Majid Jehangir
- Government Medical College, Srinagar, Jammu and Kashmir, India
| | | | | | - Sheikh Bilal
- Government Medical College, Srinagar, Jammu and Kashmir, India
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15
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Ufuk F, Yağcı AB. Letter to the Editor: "Prospective assessment of VI-RADS score in multiparametric MRI in bladder cancer: accuracy and the factors affecting the results". Diagn Interv Radiol 2023; 29:412-413. [PMID: 36987930 PMCID: PMC10679691 DOI: 10.4274/dir.2022.221568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/30/2022] [Indexed: 01/15/2023]
Affiliation(s)
- Furkan Ufuk
- Department of Radiology, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Ahmet Baki Yağcı
- Department of Radiology, Pamukkale University Faculty of Medicine, Denizli, Turkey
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16
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Kim SH, Han JH, Jeong SH, Yuk HD, Jeong CW, Kwak C, Kim HH, Kim SY, Kim TM, Cho JY, Ku JH. Accuracy of actual stage prediction using Vesical Imaging Reporting and Data System (VI-RADS) before radical cystectomy for urothelial carcinoma in SUPER-UC-Cx. Transl Androl Urol 2023; 12:168-175. [PMID: 36915877 PMCID: PMC10006012 DOI: 10.21037/tau-22-704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/16/2023] [Indexed: 02/07/2023] Open
Abstract
Background Previous studies using the Vesical Imaging Reporting and Data System (VI-RADS) to predict muscle-invasive bladder cancer (MIBC) had some limitations. Most studies were performed with transurethral resection of bladder tumor (TUR-BT) specimens with few samples. This study was conducted to address these shortcomings and confirm the accuracy of VI-RADS for bladder cancer. Methods This study used data from the Seoul National University Prospectively Enrolled Registry for Urothelial Cancer-Radical Cystectomy (SUPER-UC-Cx). Patients who underwent multiparametric magnetic resonance imaging (mp-MRI) before radical cystectomy (RC) were included in this study between March 2020 and March 2022. All images were reported by radiologists and reviewed by two urologists. The patient characteristics and clinical information were blinded during the review. The performance of qualitative and quantitative variables in predicting muscle layer invasion or perivesical fat infiltration was verified by receiver operating characteristic (ROC) curve analysis. Results Of 208 patients, 182 (87.5%) underwent mp-MRI before RC. Twenty-three patients with non-urothelial carcinoma, inappropriate MRI scans, and bladder filling were excluded. Cut-off for muscle invasion, VI-RADS score of 4 had the highest area under the curve (AUC) (sensitivity 0.84; specificity 0.93; accuracy 0.90; positive predictive value (PPV) 0.84; negative predictive value (NPV) 0.93, and AUC 0.88). Cut-off for perivesical fat invasion and VI-RADS score of 5 had the highest AUC (sensitivity, 0.78; specificity, 0.99; accuracy, 0.95; PPV, 0.96; NPV, 0.95; and AUC, 0.89). Conclusions VI-RADS is a good predictor of bladder cancer staging before RC and is especially helpful in predicting muscle invasion and perivesical fat infiltration.
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Affiliation(s)
- Si Hyun Kim
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Jang Hee Han
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Seung-Hwan Jeong
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Hyeong Dong Yuk
- Department of Urology, Seoul National University Hospital, Seoul, Korea.,Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University Hospital, Seoul, Korea.,Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University Hospital, Seoul, Korea.,Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University Hospital, Seoul, Korea.,Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Youn Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Taek Min Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Yeon Cho
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University Hospital, Seoul, Korea.,Department of Urology, Seoul National University College of Medicine, Seoul, Korea
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Gupta P, Sarangi SS, Singh M, Pandey H, Choudhary GR, Madduri VKS, Bhirud DP, Sandhu AS, Jena R. To determine correlation between VIRADS scoring and pathological staging in bladder cancer: A prospective study and review of literature. Urologia 2023:3915603231151738. [PMID: 36847430 DOI: 10.1177/03915603231151738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
The development of standardized reporting systems is of paramount importance in medical-imaging. Based on the "RADS" methodology, PIRADS and BI-RADS have been successfully used. The management of bladder cancer (BC) depends on the stage at the time of identification. Accurate assessment of the muscle-invasive stage can alter therapies that are radically different. MRI can accurately diagnose this in a standardized manner (Vesical Imaging-Reporting and Data System: VIRADS) and spare additional procedures. The aim of the study is to determine diagnostic accuracy of VIRADS scoring in evaluation of muscle invasiveness in patients with BC. This study was conducted in a single center over a period of 2 years from April 2020. A total of 76 patients with bladder SOL/diagnosed BC were included. Final VIRADS scoring was calculated and compared with histopathological report.76 patients were evaluated which included 64 males and 12 females. Most of the cases came under the VIRADS-II category (23, 30.26%) followed by VIRADS-V (17, 22.36%). VIRADS-I was reported in 14 cases (18.42%). A total of 8 cases (10.52 %) were reported as VIRADS III and 14 cases (18.42%) as VIRADS IV. VIRADS-III was taken as cut off and found to have a sensitivity of 94.44%, a specificity of 87.50%, a positive predictive value of 87.17% and a negative predictive value of 94.59%. Though number of cases are still less to accurately predict test characteristics of VIRADS, our results are consistent with previously done retrospective studies and VIRADS has got good correlation with pathological staging.
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Affiliation(s)
- Prateek Gupta
- Department of Urology, Aadhar Health Institute, Hisar, Haryana, India
| | - Shakti Swarup Sarangi
- Department of Urology All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Mahendra Singh
- Department of Urology All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Himanshu Pandey
- Department of Urooncology, MPMMC-TMH, Varanasi, Uttar Pradesh, India
| | - Gautam Ram Choudhary
- Department of Urology All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | | | - Deepak Prakash Bhirud
- Department of Urology All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Arjun Singh Sandhu
- Department of Urology All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Rahul Jena
- Department of Urology All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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18
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Lee HW, Kwon WA, Nguyen NT, Phan DTT, Seo HK. Approaches to Clinical Complete Response after Neoadjuvant Chemotherapy in Muscle-Invasive Bladder Cancer: Possibilities and Limitations. Cancers (Basel) 2023; 15. [PMID: 36831665 DOI: 10.3390/cancers15041323] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/14/2023] [Accepted: 02/18/2023] [Indexed: 02/22/2023] Open
Abstract
In the surgical oncology field, the change from a past radical surgery to an organ preserving surgery is a big trend. In muscle-invasive bladder cancer treatment, neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) is the standard of care for muscle-invasive bladder cancer (MIBC) patients eligible for cisplatin. There is a growing interest in bladder preserving strategies after NAC because good oncologic outcome has been reported for pathologic complete response (pCR) patients after NAC, and many studies have continued to discuss whether bladder preservation treatment is possible for these patients. However, in actual clinical practice, decision-making should be determined according to clinical staging and there is a gap that cannot be ignored between clinical complete response (cCR) and pCR. Currently, there is a lack in a uniform approach to post-NAC restaging of MIBC and a standardized cCR definition. In this review, we clarify the gap between cCR and pCR at the current situation and focus on emerging strategies in bladder preservation in selected patients with MIBC who achieve cCR following NAC.
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Arita Y, Yoshida S, Shigeta K, Kwee TC, Edo H, Okawara N, Hashimoto M, Ishii R, Ueda R, Mikami S, Fujiwara M, Waseda Y, Kikuchi E, Fujii Y, Jinzaki M. Diagnostic Value of the Vesical Imaging-Reporting and Data System in Bladder Urothelial Carcinoma with Variant Histology. Eur Urol Oncol 2023; 6:99-102. [PMID: 35933266 DOI: 10.1016/j.euo.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/08/2022] [Accepted: 07/20/2022] [Indexed: 11/18/2022]
Abstract
The value of the Vesicle Imaging-Reporting and Data System (VI-RADS) in the diagnosis of muscle-invasive bladder cancer (MIBC) for urothelial carcinoma with variant histology (VUC) remains unknown. We retrospectively evaluated 360 consecutive patients with bladder cancer (255 pure urothelial carcinoma [PUC] and 69 VUC) who underwent multiparametric magnetic resonance imaging between 2011 and 2019. VI-RADS scores assigned by four readers were significantly higher for the VUC group than for the PUC group (p < 0.05). In the cohort of 122 pair-matched patients, there was no significant difference in VI-RADS score distribution between the PUC and VUC groups for all readers (p > 0.05). The area under the receiver operating characteristic curve for MIBC diagnosis via overall VI-RADS score was 0.93-0.94 for PUC and 0.89-0.92 for VUC, with no significant difference between the PUC and VUC groups (p = 0.32-0.60). These data suggests that VI-RADS scores achieved high diagnostic performance for detection of muscle invasion in both PUC and VUC. PATIENT SUMMARY: The Vesical Imaging-Reporting and Data System (VI-RADS) is a standardized system for reporting on detection of muscle-invasive bladder cancer via magnetic resonance imaging (MRI) scans. Our study shows that VI-RADS is also highly accurate for diagnosis for different variants of muscle-invasive bladder cancer, with good inter-reader agreement.
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Affiliation(s)
- Yuki Arita
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan.
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Keisuke Shigeta
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Thomas C Kwee
- Department of Radiology, Nuclear Medicine, and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
| | - Hiromi Edo
- Department of Radiology, National Defense Medical College, Tokorozawa, Japan
| | - Naoko Okawara
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Hashimoto
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Ryota Ishii
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Ryo Ueda
- Office of Radiation Technology, Keio University Hospital, Tokyo, Japan
| | - Shuji Mikami
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Motohiro Fujiwara
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Yuma Waseda
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Eiji Kikuchi
- Department of Urology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
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Leonardo C, Flammia RS, Lucciola S, Proietti F, Pecoraro M, Bucca B, Licari LC, Borrelli A, Bologna E, Landini N, Del Monte M, Chung BI, Catalano C, Magliocca FM, De Berardinis E, Del Giudice F, Panebianco V. Performance of Node-RADS Scoring System for a Standardized Assessment of Regional Lymph Nodes in Bladder Cancer Patients. Cancers (Basel) 2023; 15:cancers15030580. [PMID: 36765540 PMCID: PMC9913205 DOI: 10.3390/cancers15030580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/15/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Current cross-sectional imaging modalities exhibit heterogenous diagnostic performances for the detection of a lymph node invasion (LNI) in bladder cancer (BCa) patients. Recently, the Node-RADS score was introduced to provide a standardized comprehensive evaluation of LNI, based on a five-item Likert scale accounting for both size and configuration criteria. In the current study, we hypothesized that the Node-RADS score accurately predicts the LNI and tested its diagnostic performance. METHODS We retrospectively reviewed BCa patients treated with radical cystectomy (RC) and bilateral extended pelvic lymph node dissection, from January 2019 to June 2022. Patients receiving preoperative systemic chemotherapy were excluded. A logistic regression analysis tested the correlation between the Node-RADS score and LNI both at patient and lymph-node level. The ROC curves and the AUC depicted the overall diagnostic performance. In addition, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for different cut-off values (>1, >2, >3, >4). RESULTS Overall, data from 49 patients were collected. Node-RADS assigned on CT scans images, was found to independently predict the LNI after an adjusted multivariable regression analysis, both at the patient (OR 3.36, 95%CI 1.68-9.40, p = 0.004) and lymph node (OR 5.18, 95%CI 3.39-8.64, p < 0.001) levels. Node-RADS exhibited an AUC of 0.87 and 0.91 at the patient and lymph node levels, respectively. With increasing Node-RADS cut-off values, the specificity and PPV increased from 57.1 to 97.1% and from 48.3 to 83.3%, respectively. Conversely, the sensitivity and NPV decreased from 100 to 35.7% and from 100 to 79.1%, respectively. Similar trends were recorded at the lymph node level. Potentially, Node-RADS > 2 could be considered as the best cut-off value due to balanced values at both the patient (77.1 and 78.6%, respectively) and lymph node levels (82.4 and 93.4%, respectively). CONCLUSIONS The current study lays the foundation for the introduction of Node-RADS for the regional lymph-node evaluation in BCa patients. Interestingly, the Node-RADS score exhibited a moderate-to-high overall accuracy for the identification of LNI, with the possibility of setting different cut-off values according to specific clinical scenarios. However, these results need to be validated on larger cohorts before drawing definitive conclusions.
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Affiliation(s)
- Costantino Leonardo
- Department of Maternal Infant and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy
| | - Rocco Simone Flammia
- Department of Maternal Infant and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy
| | - Sara Lucciola
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University, 00161 Rome, Italy
| | - Flavia Proietti
- Department of Maternal Infant and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy
| | - Martina Pecoraro
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University, 00161 Rome, Italy
| | - Bruno Bucca
- Department of Maternal Infant and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy
| | - Leslie Claire Licari
- Department of Maternal Infant and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy
| | - Antonella Borrelli
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University, 00161 Rome, Italy
| | - Eugenio Bologna
- Department of Maternal Infant and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy
| | - Nicholas Landini
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University, 00161 Rome, Italy
| | - Maurizio Del Monte
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University, 00161 Rome, Italy
| | - Benjamin I. Chung
- Department of Urology, Standford University School of Medicine, Standford, CA 94305, USA
| | - Carlo Catalano
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University, 00161 Rome, Italy
| | - Fabio Massimo Magliocca
- Department of Anatomopathological, Oncology and Pathology, Sapienza University, 00161 Rome, Italy
| | - Ettore De Berardinis
- Department of Maternal Infant and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy
| | - Francesco Del Giudice
- Department of Maternal Infant and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy
- Department of Urology, Standford University School of Medicine, Standford, CA 94305, USA
- Correspondence: or ; Tel.: +39-0649975463; Fax: +39-0649978509
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University, 00161 Rome, Italy
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Li DX, Wang XM, Feng DC, Zhang FC, Wu RC, Shi X, Chen K, Bai Y, Han P. 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. Front Oncol 2022; 12:937638. [PMID: 35903700 PMCID: PMC9314647 DOI: 10.3389/fonc.2022.937638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/31/2022] [Indexed: 12/03/2022] Open
Abstract
The prognostic value of the lymphocyte-to-monocyte ratio during induction (ILMR) remains unclear in non-muscle-invasive bladder cancer (NMIBC) patients receiving Bacillus Calmette-Guérin (BCG). We aimed to determine and compare the prognostic value of the ILMR, preoperative lymphocyte-to-monocyte ratio (PLMR) and their dynamic changes (PILMR). This study collected the data from NMIBC patients receiving BCG treatment in our institution. The prognostic value of the PLMR, ILMR and PILMR was analyzed by the Kaplan−Meier method and Cox proportional hazard regression models. The concordance index and receiver operating characteristic curve analysis were employed to compare the prognostic value of these three factors. Our study enrolled 197 patients. These patients included 170 male patients, and the mean age was 64.17 years. During the follow-up time, 85 patients experienced recurrence, and 55 patients experienced progression. According to the results of COX multivariable analysis, PLMR (P=0.011) and ILMR (P<0.001) could independently predict the recurrence of NMIBC patients receiving BCG. Meanwhile, ILMR (P=0.001) and PILMR (P=0.036) were also the independent prognostic factors of progression. Compared with PLMR and PILMR, ILMR was associated with better accuracy for NMIBC patients receiving BCG. This study first found that the ILMR could independently predict the prognosis of NMIBC patients receiving BCG. Furthermore, we also identified that ILMR was associated with higher prognostic value than PLMR and PILMR, which might help to select an optimal treatment schedule for patients with NMIBC.
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Baroni RH. A brief review of the VI-RADS classification for bladder tumors on MRI (and a call for increased interface, consistent communication and more joined studies by the radiological and urological communities). Int Braz J Urol 2022; 48:623-624. [PMID: 35594322 PMCID: PMC9306376 DOI: 10.1590/s1677-5538.ibju.2021.0560.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/26/2022] [Indexed: 11/22/2022] Open
Affiliation(s)
- Ronaldo Hueb Baroni
- Departamento de Radiologia, Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, SP. Brasil
- Departamento de Imagem, Hospital Israelita Albert Einstein São Paulo, SP, Brasil
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