VI-RADS-based Algorithm for Bladder Cancer Management Randomized Retrospective Study

Area of Science:

• Uro-oncology
• Radiology
• Medical imaging

Background:

• Distinguishing nonmuscle-invasive bladder cancer (NMIBC) from muscle-invasive bladder cancer (MIBC) is critical for treatment planning.
• The Vesical Imaging-Reporting and Data System (VI-RADS) is a scoring system used with MRI to assess bladder cancer invasiveness.
• The utility of VI-RADS in replacing or guiding repeated transurethral resection of bladder tumor (Re-TURBT) requires further evaluation.

Purpose of the Study:

• To determine if VI-RADS can differentiate between NMIBC, MIBC, and high-risk NMIBC (HR-NMIBC).
• To assess the potential of VI-RADS to replace Re-TURBT within a new VI-RADS-based algorithm.

Main Methods:

• Calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of VI-RADS scores.
• Evaluated mpMRI performance in patients undergoing TURBT and HR-NMIBC patients undergoing Re-TURBT.
• Assessed a new VI-RADS-based algorithm for guiding treatment decisions.

Main Results:

• VI-RADS ≥3 demonstrated high accuracy in identifying muscle-invasive disease (sensitivity 95.7%, specificity 92.5%, AUC 0.942).
• In patients undergoing Re-TURBT, 46% were tumor-free, 50.5% had persistent HR-NMIBC, and 2.2% were upgraded to MIBC.
• The VI-RADS-based approach suggested avoiding Re-TURBT in 41% of HR-NMIBCs with VI-RADS ≤2, but residual disease remained high (39.7%) even after excluding incomplete resections.

Conclusions:

• VI-RADS ≥4 facilitated switching to radical treatment for muscle-invasive bladder cancer.
• Despite potential benefits for muscle-invasive cases, TURBT should be continued for HR-NMIBCs with VI-RADS ≤2 due to high rates of residual disease.