VI-RADS-based algorithm for bladder cancer management: randomized retrospective study

Abstract

OBJECTIVE To evaluate if VI-RADS can distinguish between nonmuscle-invasive bladder cancers (NMIBC), muscle-invasive bladder cancer (MIBC), and high-risk nonmuscle-invasive bladder cancers (HR-NMIBCs). It is unclear if the Vesical Imaging-Reporting and Data System (VIRADS) can replace repeated transurethral resection of bladder tumor (Re-TURBT) as in the new VI-RADS-based algorithm. METHODS Sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values of the VIRADS score were calculated for mpMRI performance in patients undergoing TURBT and HRNMIBC patients for only Re-TURBT. RESULTS Of 283 cases, when VI-RADS >= 3 lesions were considered muscle-invasive, its sensitivity was 95.7% and specificity was 92.5%. PPV and NPV were 86.6% and 97.7%, respectively. The area under the curve (AUC) was 0.942 (P < .001). Of 89 patients undergoing post-Re-TURBT, 41 (46%) were tumor-free, 47 (50.5%) showed permanent HR-NMIBC, and 3 (2.2%) were upgraded to MIBC. Per the new VI-RADS-based approach, 73 (41%) of the 178 HR-NMIBCs with VI-RADS <= 2 would not undergo Re-TURBT. Of the 75 patients with VI-RADS >= 4, 6 (6) with HR-NMIBCs (8%) would not undergo Re-TURBT. When incomplete resections were excluded, 35 (60.3%) of the patients had complete resection, 23 (39.7%) had residual disease, and complete resection would not have been performed in these patients, and 2 (100%) still had residual disease. CONCLUSION The new VI-RADS-based algorithm helped VI-RADS >= 4 patients by switching to radical treatment. Since the residual disease is high in cases with VI-RADS <= 2, even if incomplete resections are excluded, TURBT should be continued. UROLOGY 194: 225-230, 2024. (c) 2024 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.