Purpose 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. Method and Materials 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. Results 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). Conclusions 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.

A novel pathway to detect muscle-invasive bladder cancer based on integrated clinical features and VI-RADS score on MRI: results of a prospective multicenter study / Bicchetti, Marco; Simone, Giuseppe; Giannarini, Gianluca; Girometti, Rossano; Briganti, Alberto; Brunocilla, Eugenio; Cardone, Gianpiero; De Cobelli, Francesco; Gaudiano, Caterina; Del Giudice, Francesco; Flammia, Simone; Leonardo, Costantino; Pecoraro, Martina; Schiavina, Riccardo; Catalano, Carlo; Panebianco, Valeria. - In: LA RADIOLOGIA MEDICA. - ISSN 0033-8362. - 127:8(2022), pp. 881-890. [10.1007/s11547-022-01513-5]

A novel pathway to detect muscle-invasive bladder cancer based on integrated clinical features and VI-RADS score on MRI: results of a prospective multicenter study

Bicchetti, Marco
Primo
;
Del Giudice, Francesco;Flammia, Simone;Leonardo, Costantino;Pecoraro, Martina;Catalano, Carlo
Penultimo
;
Panebianco, Valeria
Ultimo
2022

Abstract

Purpose 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. Method and Materials 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. Results 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). Conclusions 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.
2022
hematuria; magnetic resonance imaging; muscle-invasive bladder cancer; pathway; VI-RADS
01 Pubblicazione su rivista::01a Articolo in rivista
A novel pathway to detect muscle-invasive bladder cancer based on integrated clinical features and VI-RADS score on MRI: results of a prospective multicenter study / Bicchetti, Marco; Simone, Giuseppe; Giannarini, Gianluca; Girometti, Rossano; Briganti, Alberto; Brunocilla, Eugenio; Cardone, Gianpiero; De Cobelli, Francesco; Gaudiano, Caterina; Del Giudice, Francesco; Flammia, Simone; Leonardo, Costantino; Pecoraro, Martina; Schiavina, Riccardo; Catalano, Carlo; Panebianco, Valeria. - In: LA RADIOLOGIA MEDICA. - ISSN 0033-8362. - 127:8(2022), pp. 881-890. [10.1007/s11547-022-01513-5]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1664765
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