Marchioni Michele, Primiceri Giulia, Delli Pizzi Andrea, Basilico Raffaella, Berardinelli Francesco, Mincuzzi Erica, Castellucci Roberto, Sessa Barbara, Di Nicola Marta, Schips Luigi
Department of Medical, Oral and Biotechnological Sciences, G. d'Annunzio University of Chieti, Urology Unit, SS Annunziata Hospital, Chieti, Italy; Laboratory of Biostatistics, Department of Medical, Oral and Biotechnological Sciences, G. d'Annunzio University of Chieti, Chieti, Italy.
Department of Medical, Oral and Biotechnological Sciences, G. d'Annunzio University of Chieti, Urology Unit, SS Annunziata Hospital, Chieti, Italy.
Clin Genitourin Cancer. 2020 Oct;18(5):409-415.e1. doi: 10.1016/j.clgc.2020.03.002. Epub 2020 Mar 13.
The Vesical Imaging Reporting and Data System (VI-RADS) was recently introduced as a standardized approach to reporting multiparametric magnetic resonance imaging (mpMRI) for bladder cancer. We aimed to prospectively analyze its routine use and its diagnostic performance in discriminating non-muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC).
A total of 38 patients with diagnosis of suspect bladder cancer at cystoscopy underwent bladder mpMRI before transurethral resection of the bladder (TURB). Bladder tumors were categorized according to the VI-RADS. After TURB, the VI-RADS score was compared with histological report for each lesion separately. Receiving operating characteristic and decision curve analyses were used to assess its accuracy and clinical utility.
A total of 68 lesions were included, of which 7 (10.3%) were MIBC. The pooled accuracy was 90.0% (95% confidence interval [CI], 75.4%-98.7%). The best threshold was estimated as VI-RADS 4, showing a sensitivity of 85.7% (95% CI, 57.1%-100%) and a specificity of 86.9% (95% CI, 78.7%-95.1%). Decision curve analyses showed that using VI-RADS ≥4 improved the net benefit compared with any default strategy for threshold probabilities of MIBC up to ∼40%, which is a reasonable clinical threshold for planning further treatments.
Our prospective study shows that the use of VI-RADS as a standardized reporting method is appealing and could be considered in clinical practice owing to its high accuracy.
膀胱影像报告和数据系统（VI-RADS）最近被引入，作为膀胱癌多参数磁共振成像（mpMRI）报告的标准化方法。我们旨在前瞻性分析其在鉴别非肌层浸润性膀胱癌（NMIBC）和肌层浸润性膀胱癌（MIBC）中的常规应用及其诊断性能。
共有38例在膀胱镜检查时诊断为疑似膀胱癌的患者在经尿道膀胱肿瘤切除术（TURB）前行膀胱mpMRI检查。膀胱肿瘤根据VI-RADS进行分类。TURB术后，将每个病变的VI-RADS评分与组织学报告进行单独比较。采用接受操作特征分析和决策曲线分析来评估其准确性和临床实用性。
共纳入68个病变，其中7个（10.3%）为MIBC。汇总准确率为90.0%（95%置信区间[CI]，75.4%-98.7%）。最佳阈值估计为VI-RADS 4，灵敏度为85.7%（95% CI，57.1%-100%），特异度为86.9%（95% CI，78.7%-95.1%）。决策曲线分析表明，对于MIBC阈值概率高达约40%的情况，使用VI-RADS≥4与任何默认策略相比可提高净效益，这是规划进一步治疗的合理临床阈值。
我们的前瞻性研究表明，将VI-RADS用作标准化报告方法具有吸引力，因其准确性高，可在临床实践中考虑使用。
