The efficacy and reliability of VI-RADS in determining candidates for repeated transurethral resection in patients with high-risk non-muscle invasive bladder cancer

Objective: Our study aims to evaluate the efficiency and reliability of Vesical Imaging Reporting Data System (VI-RADS) in prospectively identifying the patients to undergo RE-TURBT in the management of patients with high-risk non-muscle invasive Bladder Cancer(HR-NMIBC). The secondary objective was to evaluate the performance of the VI-RADS scoring system in differentiating between muscle-invasive bladder cancer (MIBC) and non-muscle invasive bladder cancer(NMIBC) prospectively. Methods: The study included 330 patients who underwent transurethral resection of bladder tumour(TURBT) for Bladder Cancer (BC) in our clinic. All patients underwent multiparametric-magnetic resonance imaging (Mp-MRI) before the operation and VI-RADS scoring was administered. The cut-off value of VI-RADS was accepted as three and above. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for the differentiation between NMIBC and MIBC distinction in all patients. Receiver operating characteristic (ROC) analysis was performed to evaluate the performance of the VI-RADS scoring system. In the second phase of the study, patients with MIBC and low-risk NMIBC (LR-NMBIC) were excluded and 158 patients with HR-NMIBC were included, and their sensitivity, specificity, PPV and NPV values were measured. ROC analysis was performed. Results: In all patients, sensitivity, specificity, PPV and NPV values of the VI-RADS scoring in the differentiation of MIBC and NMIBC were 91.3, 91.8, 81.7 and 96.3 respectively. The AUC value was 0.934 (95%CI: 0.903-0.964). Sensitivity, specificity, PPV and NPV values were found to be 87, 91.8, 74.1, 95.2 in the evaluation specifically made for patients with HR-NMIBC. The AUC value was 0.900 (95% CI:0.843-0.957). Inter-reader agreement was excellent (K = 0.90, 95% CI:0.71-0.95). Conclusions: The VI-RADS scoring system is an effective and reliable method in determining the patients who will undergo RE-TURBT and in differentiating MIBC and NMIBC.

Automated summary

The study evaluated the effectiveness and reliability of the VI-RADS scoring system in identifying patients with high-risk non-muscle invasive bladder cancer for RE-TURBT and distinguishing between MIBC and NMIBC. The system demonstrated high sensitivity and accuracy in all patients, with good performance in HR-NMIBC patients specifically.