Prospective Evaluation of the Effect of Vesical Imaging Reporting and Data System Scoring on the Identification of Candidates for Repeated Transurethral Resection

Abstract

Background: To determine the diagnostic accuracy of the Vesical Imaging Reporting and Data System (VI-RADS) scoring system in identifying candidates for second transurethral resection (reTUR-BT) and investigate the success of VI-RADS in detecting muscle-invasive bladder cancer (MIBC). Methods: Data from 186 patients who underwent primary TUR-BT for bladder cancer (BC) at our center between April 2022 and April 2023 were prospectively collected. Preoperative bladder multiparametric magnetic resonance imaging was performed for all patients to determine the VI-RADS score. A cutoff value of VI-RADS ≥4 was accepted for detecting muscle invasion. Sensitivity, specificity, positive predictive value, negative predictive value, and the area under the curve (AUC) were calculated to evaluate the performance of VI-RADS in distinguishing MIBC from non-muscle-invasive bladder cancer (NMIBC) after primary TUR-BT. In the second phase, following the application of exclusion criteria, the study proceeded with 52 patients who underwent reTUR-BT, the primary target population of the study. Preoperatively calculated VI-RADS scores were compared with reTUR-BT pathology findings. Results: VI-RADS scoring was statistically significant in distinguishing MIBC from NMIBC. However, the performance of VI-RADS in identifying persistent NMIBC and upstaged MIBC in patients undergoing reTUR-BT was statistically nonsignificant. For VI-RADS ≥4, the sensitivity was 45.4%, specificity was 90.2%, PPV was 55.5%, and NPV was 86%. The AUC was 0.67 (95% confidence interval: 0.46-0.88; P = .079). Conclusions: Histopathologic sampling via reTUR-BT remains the gold standard, and the performance of VI-RADS in identifying candidates for reTUR-BT has been found to be suboptimal.

Keywords: Vesical Imaging Reporting and Data System; bladder cancer; multiparametric MRI; second transurethral bladder resection.