A recent study evaluated the diagnostic and predictive accuracy of VI-RADS. The retrospective study cohort included 283 patients with suspected primary BC who underwent multiparametric MRI (mpMRI) before TURBT. The VI-RADS algorithm categorizes patients according to a computed score reflecting the probability of muscle invasiveness (≤2: low probability, 3: questionable, ≥4: high probability). The sensitivity and specificity rates of VI-RADS in distinguishing NMIBC from MIBC among patients with a score of at least 3 were 95.7% and 92.5%, respectively. The positive predictive value (PPV) was 86.6%, while the negative predictive value (NPV) was 97.7%. In patients with a VI-RADS score of 4 or more, sensitivity was 77.8%, specificity was 99.4%, PPV was 98.6%, and NPV was 89.9%.
The investigators subsequently tested whether VI-RADS evaluation could have prevented high-risk NMIBC patients from undergoing repeated TURBT (Re-TURBT). This analysis revealed that 41% of high-risk NMIBC patients with a VI-RADS score of ≤2 would not have received Re-TURBT. In patients with a VI-RADS score of 3, 66.7% would not have undergone Re-TURBT. In patients with a VI-RADS score of ≥4, 8% would not have undergone Re-TURBT.
The VI-RADS-based approach exhibits high accuracy as a promising alternative to unnecessary TURBT procedures. However, this technique is associated with some technical limitations. Importantly, while VI-RADS may accurately reflect invasiveness, it does not enable tumor resection as TURBT does. Future research is needed to refine VI-RADS-based protocols and to define optimal patients for less invasive imaging-guided treatment pathways.
Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine
References:
- Şam Özdemir M, Keskin ET, Savun M, Yüzkan S, Kaya N, Özdemir H. VI-RADS-based Algorithm for Bladder Cancer Management Randomized Retrospective Study. Urology. Published online October 18, 2024. doi:10.1016/j.urology.2024.10.002