To determine the clinical, pathological, and radiological features, including the Vesical Imaging-Reporting and Data System (VI-RADS) score, independently correlating with muscle-invasive bladder cancer (BCa), in a multicentric national setting.
Patients with BCa suspicion were offered magnetic resonance imaging (MRI) before trans-urethral resection of bladder tumor (TURBT). According to VI-RADS, a cutoff of ≥ 3 or ≥ 4 was assumed to define muscle-invasive bladder cancer (MIBC). Trans-urethral resection of the tumor (TURBT) and/or cystectomy reports were compared with preoperative VI-RADS scores to assess accuracy of MRI for discriminating between non-muscle-invasive versus MIBC. Performance was assessed by ROC curve analysis. Two univariable and multivariable logistic regression models were implemented including clinical, pathological, radiological data, and VI-RADS categories to determine the variables with an independent effect on MIBC.
A final cohort of 139 patients was enrolled (median age 70 [IQR: 64, 76.5]). MRI showed sensitivity, specificity, PPV, NPV, and accuracy for MIBC diagnosis ranging from 83-93%, 80-92%, 67-81%, 93-96%, and 84-89% for the more experienced readers. The area under the curve (AUC) was 0.95 (0.91-0.99). In the multivariable logistic regression model, the VI-RADS score, using both a cutoff of 3 and 4 (P < .0001), hematuria (P = .007), tumor size (P = .013), and concomitant hydronephrosis (P = .027) were the variables correlating with a bladder cancer staged as ≥ T2. The inter-reader agreement was substantial (k = 0.814).
VI-RADS assessment scoring proved to be an independent predictor of muscle-invasiveness, which might implicate a shift toward a more aggressive selection approach of patients' at high risk of MIBC, according to a novel proposed predictive pathway.
La Radiologia medica. 2022 Jun 28 [Epub ahead of print]
Marco Bicchetti, Giuseppe Simone, Gianluca Giannarini, Rossano Girometti, Alberto Briganti, Eugenio Brunocilla, Gianpiero Cardone, Francesco De Cobelli, Caterina Gaudiano, Francesco Del Giudice, Simone Flammia, Costantino Leonardo, Martina Pecoraro, Riccardo Schiavina, Carlo Catalano, Valeria Panebianco
Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161, Rome, Italy., Department of Urology, 'Regina Elena' National Cancer Institute, IRCCS, Rome, Italy., Unit of Urology, Santa Maria della Misericordia Academic Medical Center, Udine, Italy., Institute of Radiology, Santa Maria della Misericordia Academic Medical Center, Udine, Italy., Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS Vita-Salute San Raffaele University, Milan, Italy., Department of Urology, University of Bologna, Bologna, Italy., Department of Radiology, IRCCS Ospedale San Raffaele Di Turro, Milan, Italy., Department of Radiology, IRCSS Vita-Salute San Raffaele University, Milan, Italy., Department of Radiology, University of Bologna, Bologna, Italy., Department of Maternal-Infant and Urological Sciences, Sapienza University/Policlinico Umberto I, Rome, Italy., Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161, Rome, Italy. .