Department of Urology, Kyorin University School of Medicine, Tokyo, Japan.
Department of Radiology, Kyorin University School of Medicine, Tokyo, Japan.
Clin Genitourin Cancer. 2022 Aug;20(4):e291-e295. doi: 10.1016/j.clgc.2022.03.002. Epub 2022 Mar 4.
Transurethral resection of bladder tumor (TURBT) is the essential first step in the current algorithm for the management of bladder cancer (BC). However, despite its necessity and significance, TURBT has several limitations, including cost, hospitalization, anesthesia, potential complications such as bladder perforation, and delay to radical cystectomy. The Vesical Imaging Reporting and Data System (VI-RADS) was developed to standardize the reporting of multiparametric magnetic resonance imaging for BC, and its diagnostic accuracy to predict muscle invasion has been validated. Given the high sensitivity of VI-RADS ≥ 3 and high specificity of VI-RADS ≥ 4 as clinically relevant cutoff values, we herein propose a new VI-RADS-based algorithm for the management of BC. Using this algorithm, patients with VI-RADS ≤ 2 may not need to undergo sampling of the detrusor muscle nor second TURBT even if there is no muscle in the initial TURBT specimen, whereas patients with VI-RADS ≥ 4 may skip conventional TURBT aimed at pathologic confirmation of muscle invasion and immediately undergo radical cystectomy. Our newly proposed algorithm enables the avoidance of unnecessary deep resection or second TURBT as well as delay to radical cystectomy. The VI-RADS-based algorithm enables a paradigm shift from the current TURBT-dependent practice in the management of BC.
经尿道膀胱肿瘤切除术（TURBT）是当前膀胱癌（BC）管理算法的重要第一步。然而，尽管 TURBT 具有必要性和重要性，但它存在一些局限性，包括成本、住院时间、麻醉、膀胱穿孔等潜在并发症以及对根治性膀胱切除术的延迟。Vesical Imaging Reporting and Data System（VI-RADS）的开发是为了标准化 BC 的多参数磁共振成像报告，其诊断准确性已被验证可预测肌肉侵犯。鉴于 VI-RADS≥3 的高敏感性和 VI-RADS≥4 的高特异性作为临床相关的截止值，我们在此提出了一种基于 VI-RADS 的新 BC 管理算法。使用该算法，VI-RADS≤2 的患者即使初始 TURBT 标本中没有肌肉，也可能不需要对逼尿肌进行取样，也不需要进行第二次 TURBT，而 VI-RADS≥4 的患者可能可以跳过旨在病理确认肌肉侵犯的常规 TURBT，直接进行根治性膀胱切除术。我们新提出的算法可以避免不必要的深度切除或第二次 TURBT 以及对根治性膀胱切除术的延迟。基于 VI-RADS 的算法使 BC 管理从当前依赖 TURBT 的实践范式发生转变。
