Klempfner Hugo, Anderson Paul
Department of Medicine, Melbourne Health and Northern Health The University of Melbourne Victoria Melbourne Australia.
Department of Urology Royal Melbourne Hospital Melbourne Australia.
BJUI Compass. 2024 Apr 24;5(7):651-661. doi: 10.1002/bco2.365. eCollection 2024 Jul.
Bladder cancer (BCa) is characterised by high prevalence, multifocality, and frequent recurrence, imposing significant clinical and economic burdens. Accurate staging, particularly distinguishing non-muscle-invasive bladder cancer (NMIBC) from muscle-invasive bladder cancer (MIBC) disease, is crucial for guiding treatment decisions. This narrative review explores the potential implications of incorporating multiparametric magnetic resonance imaging (mpMRI) and the Vesical Imaging Reporting Data System (VI-RADS) into BCa staging, focusing on repeat transurethral resection of bladder tumour (re-TURBT).
A comprehensive search of PubMed, EMBASE, and MEDLINE databases identified studies published from 2018 to 2023 discussing mpMRI or VI-RADS in the context of re-TURBT for BCa staging. Studies meeting inclusion criteria underwent qualitative analysis.
Six recent studies met inclusion criteria. VI-RADS scoring, accurately predicted muscle invasion, aiding in NMIBC/MIBC differentiation. VI-RADS scores of ≥3 indicated MIBC with high sensitivity and specificity. VI-RADS potentially identified patients benefiting from re-TURBT and those for whom it could be safely omitted.
mpMRI and VI-RADS offer promising prospects for BCa staging, potentially correlating more closely with re-TURBT and radical cystectomy histopathology than initial TURBT. However, validation and careful evaluation of clinical integration are needed. Future research should refine patient selection and optimise mpMRI's role in BCa management.
VI-RADS scoring could revolutionise BCa staging, especially regarding re-TURBT. There is potential that VI-RADS correlates more with the histopathology of re-TURBT and radical cystectomy than initial TURBT. While promising, ongoing research is essential to validate utility, refine selection criteria, and address economic considerations. Integration of VI-RADS into BCa staging holds potential benefits for patients and health care systems.
膀胱癌（BCa）具有高患病率、多灶性和频繁复发的特点，带来了重大的临床和经济负担。准确分期，特别是区分非肌层浸润性膀胱癌（NMIBC）和肌层浸润性膀胱癌（MIBC），对于指导治疗决策至关重要。本叙述性综述探讨了将多参数磁共振成像（mpMRI）和膀胱影像报告与数据系统（VI-RADS）纳入BCa分期的潜在意义，重点关注膀胱肿瘤重复经尿道切除术（re-TURBT）。
全面检索PubMed、EMBASE和MEDLINE数据库，确定2018年至2023年发表的在re-TURBT用于BCa分期背景下讨论mpMRI或VI-RADS的研究。符合纳入标准的研究进行定性分析。
最近六项研究符合纳入标准。VI-RADS评分准确预测了肌肉浸润情况，有助于NMIBC/MIBC的鉴别。VI-RADS评分≥3表明为MIBC，具有高敏感性和特异性。VI-RADS有可能识别出从re-TURBT中获益的患者以及可以安全省略该手术的患者。
mpMRI和VI-RADS在BCa分期方面前景广阔，与re-TURBT和根治性膀胱切除术组织病理学的相关性可能比初次经尿道膀胱肿瘤切除术（TURBT）更紧密。然而，需要进行验证和对临床整合进行仔细评估。未来的研究应优化患者选择并优化mpMRI在BCa管理中的作用。
VI-RADS评分可能会彻底改变BCa分期，特别是在re-TURBT方面。VI-RADS与re-TURBT和根治性膀胱切除术的组织病理学相关性可能比初次TURBT更强。虽然前景乐观，但持续的研究对于验证其效用、完善选择标准和解决经济问题至关重要。将VI-RADS纳入BCa分期对患者和医疗保健系统具有潜在益处。
