Zhongguo aizheng zazhi (Mar 2023)
The value of VI-RADS combined with tumor contact length in the detection of muscle-invasive bladder cancer
Abstract
Background and purpose: The value of Vesical Imaging-Reporting and Data System (VI-RADS) based on multiparametric magnetic resonance imaging (MRI) in the preoperative assessment of bladder cancer muscle-invasive is increasingly recognized. However, there is still a high number of false positives when the diagnostic cut-off value is 3 points. Tumor size has certain auxiliary diagnostic value in the assessment of tumor infiltration. Therefore, this study mainly explored the diagnostic performance of VI-RADS combined with tumor size in assessing bladder cancer muscle-invasive. Methods: The preoperative bladder multiparametric MRI and clinical data of 119 patients with bladder cancer confirmed by surgery and pathology (a total of 159 lesions) who were treated in Fudan University Shanghai Cancer Center from November 2019 to February 2022 were retrospectively collected. VI-RADS score and tumor contact length (TCL) measurements were performed independently for each lesion by two radiologists. Lesions with differences in score or size were given consistent results following discussion by two physicians. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic performance of VI-RADS, TCL and their combined models for muscle invasion, and the corresponding area under curve (AUC), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy were compared. Results: Postoperative pathology confirmed that there were 75 and 84 lesions of non-muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC), respectively. The mean TCL of MIBC group (6.15-6.23 cm) was significantly different from that of NMIBC group (2.26-2.35 cm), and the difference was statistically significant (P<0.05). The specificity, PPV and diagnostic accuracy of VI-RADS combined with TCL in predicting bladder cancer muscle-invasive were significantly higher than those of VI-RADS with a diagnostic threshold of 3 points alone (P<0.05), whereas there was no statistically significant difference in the sensitivity and NPV (P>0.05). There was no significant difference in AUC between TCL (AUC = 0.89), VI-RADS (AUC = 0.90) and VI-RADS combined with TCL (AUC = 0.91) (P>0.05). Conclusion: VI-RADS combined with TCL can reduce the false positive rate of VI-RADS 3-point lesions in the evaluation of bladder cancer muscle-invasive to a certain extent, which is beneficial for avoiding overtreatment.
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