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Yu R, Cai L, Cao Q, Liu P, Gong Y, Li K, Wu Q, Zhang Y, Li P, Yang X, Lu Q. Development and Validation of an MRI-Based Nomogram for Preoperative Detection of Muscle Invasion in VI-RADS 3. J Magn Reson Imaging 2024; 60:448-457. [PMID: 37902432 DOI: 10.1002/jmri.29103] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/15/2023] [Accepted: 10/17/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND The relationship between tumor and muscle layer in the vesical imaging-reporting and data system (VI-RADS) 3 is ambiguous, and there is a lack of preoperative and non-invasive procedures to detect muscle invasion in VI-RADS 3. PURPOSE To develop a nomogram based on MRI features for detecting muscle invasion in VI-RADS 3. STUDY TYPE Retrospective. POPULATION 235 cases (Age: 67.5 ± 11.5 years) with 11.9% females were randomly divided into a training cohort (n = 164) and a validation cohort (n = 71). FIELD STRENGTH/SEQUENCE 3T, T2-weighted imaging (turbo spin-echo), diffusion-weighted imaging (breathing-free spin echo), and dynamic contrast-enhanced imaging (gradient echo). ASSESSMENT 3 features were selected from the training cohort, including tumor contact length greater than maximum tumor diameter (TCL > Dmax), flat tumor morphology, and lower standard deviation of apparent diffusion coefficient (ADCSD). Three readers assessed VI-RADS scores and the tumor morphology. STATISTICAL TESTS Interobserver agreement was assessed by Kappa analysis. Features for final analysis were selected by logistic regression. The performance of the nomogram was evaluated by the receiver operating characteristic curve, decision curve analysis, and calibration curve. RESULTS TCL > Dmax, flat morphology, and lower ADCSD were the independent risk factors for muscle invasive in VI-RADS 3. The AUCs, accuracy, sensitivity, and specificity of the nomogram 1 composed of three features for detecting muscle invasion were 0.852 (95% CI: 0.793-0.912), 0.756, 0.917, and 0.663 in the training cohort, and 0.885 (95% CI: 0.801-0.969), 0.817, 0.900, and 0.784 in the validation cohort. The nomogram 2 without ADCSD has nearly the same performance as the nomogram 1. DATA CONCLUSION Nomogram can be an efficient tool for preoperative detection of muscle invasion in VI-RADS 3. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Ruixi Yu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lingkai Cai
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Department of Urology, Wuxi Medical Center, Nanjing Medical University, Wuxi, China
| | - Qiang Cao
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Peikun Liu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yuxi Gong
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kai Li
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qikai Wu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yudong Zhang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Pengchao Li
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiao Yang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qiang Lu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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James N, Pirrie S, Liu W, Catto J, Jefferson K, Patel P, Hughes A, Pope A, Nanton V, Mintz HP, Knight A, Gallagher J, Bryan RT. Image directed redesign of bladder cancer treatment pathways: the BladderPath RCT. Health Technol Assess 2024; 28:1-65. [PMID: 39246267 DOI: 10.3310/deht5407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2024] Open
Abstract
Background Transurethral resection of bladder tumour has been the mainstay of bladder cancer staging for > 60 years. Staging inaccuracies are commonplace, leading to delayed treatment of muscle-invasive bladder cancer. Multiparametric magnetic resonance imaging offers rapid, accurate and non-invasive staging of muscle-invasive bladder cancer, potentially reducing delays to radical treatment. Objectives To assess the feasibility and efficacy of the introducing multiparametric magnetic resonance imaging ahead of transurethral resection of bladder tumour in the staging of suspected muscle-invasive bladder cancer. Design Open-label, multistage randomised controlled study in three parts: feasibility, intermediate and final clinical stages. The COVID pandemic prevented completion of the final stage. Setting Fifteen UK hospitals. Participants Newly diagnosed bladder cancer patients of age ≥ 18 years. Interventions Participants were randomised to Pathway 1 or 2 following visual assessment of the suspicion of non-muscle-invasive bladder cancer or muscle-invasive bladder cancer at the time of outpatient cystoscopy, based upon a 5-point Likert scale: Likert 1-2 tumours considered probable non-muscle-invasive bladder cancer; Likert 3-5 possible muscle-invasive bladder cancer. In Pathway 1, all participants underwent transurethral resection of bladder tumour. In Pathway 2, probable non-muscle-invasive bladder cancer participants underwent transurethral resection of bladder tumour, and possible muscle-invasive bladder cancer participants underwent initial multiparametric magnetic resonance imaging. Subsequent therapy was determined by the treating team and could include transurethral resection of bladder tumour. Main outcome measures Feasibility stage: proportion with possible muscle-invasive bladder cancer randomised to Pathway 2 which correctly followed the protocol. Intermediate stage: time to correct treatment for muscle-invasive bladder cancer. Results Between 31 May 2018 and 31 December 2021, of 638 patients approached, 143 participants were randomised; 52.1% were deemed as possible muscle-invasive bladder cancer and 47.9% probable non-muscle-invasive bladder cancer. Feasibility stage: 36/39 [92% (95% confidence interval 79 to 98%)] muscle-invasive bladder cancer participants followed the correct treatment by pathway. Intermediate stage: median time to correct treatment was 98 (95% confidence interval 72 to 125) days for Pathway 1 versus 53 (95% confidence interval 20 to 89) days for Pathway 2 [hazard ratio 2.9 (95% confidence interval 1.0 to 8.1)], p = 0.040. Median time to correct treatment for all participants was 37 days for Pathway 1 and 25 days for Pathway 2 [hazard ratio 1.4 (95% confidence interval 0.9 to 2.0)]. Limitations For participants who underwent chemotherapy, radiotherapy or palliation for multiparametric magnetic resonance imaging-diagnosed stage T2 or higher disease, it was impossible to conclusively know whether these were correct treatments due to the absence of histopathologically confirmed muscle invasion, this being confirmed radiologically in these cases. All patients had histological confirmation of their cancers. Due to the COVID-19 pandemic, we were unable to realise the final stage. Conclusion The multiparametric magnetic resonance imaging-directed pathway led to a substantial 45-day reduction in time to correct treatment for muscle-invasive bladder cancer, without detriment to non-muscle-invasive bladder cancer participants. Consideration should be given to the incorporation of multiparametric magnetic resonance imaging ahead of transurethral resection of bladder tumour into the standard pathway for all patients with suspected muscle-invasive bladder cancer. The improved decision-making accelerated time to treatment, even though many patients subsequently needed transurethral resection of bladder tumour. A proportion of patients can avoid transurethral resection of bladder tumour completely, reducing costs and morbidity, given the much lower cost of magnetic resonance imaging and biopsy compared to transurethral resection of bladder tumour. Future work Further work to cross-correlate with the recently developed Vesical Imaging-Reporting and Data System will improve accuracy and aid dissemination. Longer follow-up to examine the effect of the pathway on outcomes is also required. Incorporation of liquid deoxyribonucleic acid-based biomarkers may further improve the quality of decision-making and should also be investigated further. Study registration This study is registered as ISRCTN 35296862. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR135775) and is published in full in Health Technology Assessment; Vol. 28, No. 42. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
| | - Sarah Pirrie
- Cancer Research Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Wenyu Liu
- Cancer Research Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - James Catto
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Kieran Jefferson
- Department of Urology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Prashant Patel
- Institute of Cancer and Genomic Sciences, University of Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ana Hughes
- Cancer Research Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Ann Pope
- Cancer Research Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | | | - Harriet P Mintz
- Cancer Research Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Medical School, University of Birmingham, Birmingham, UK
| | - Allen Knight
- Patient and Public Involvement Representatives, Gallagher, Bradford Knight, Basingstoke, UK
| | - Jean Gallagher
- Patient and Public Involvement Representatives, Gallagher, Bradford Knight, Basingstoke, UK
| | - Richard T Bryan
- Bladder Cancer Research Centre, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
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Kozikowski M, Zagrodzka M, Zawadzki M, Zugaj P, Osiecki R, Rzymkowski F, Śledź M, Sosnowski R, Dobruch J, Giudice FD, Krajewski W. The role of VI-RADS scoring criteria for predicting oncological outcomes in bladder cancer. World J Urol 2024; 42:438. [PMID: 39046595 PMCID: PMC11269435 DOI: 10.1007/s00345-024-05101-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 05/31/2024] [Indexed: 07/25/2024] Open
Abstract
PURPOSE Our purpose was to evaluate the prognostic value of Vesical Imaging Reporting and Data System (VI-RADS) in bladder cancer (BCa) staging and predicting recurrence or progression. METHODS We retrospectively analyzed the prospectively collected data from 96 patients with bladder tumors who underwent VI-RADS-based multiparametric magnetic resonance imaging (mpMRI) before endourological treatment from April 2021 to December 2022. Diagnostic performance was evaluated by comparing mpMRI reports with final pathology, using logistic regression for muscle-invasive bladder cancer (MIBC) predictors. Follow-up until May 2023 included Kaplan-Meier and Cox regression analysis to assess VI-RADS predictive roles for recurrence-free survival (RFS) and progression-free survival (PFS). RESULTS A total of 96 patients (19.8% women, 80.2% men; median age 68.0 years) were included, with 71% having primary tumors and 29% recurrent BCa. Multiparametric MRI exhibited high sensitivity (92%) and specificity (79%) in predicting MIBC, showing no significant differences between primary and recurrent cancers (AUC: 0.96 vs. 0.92, P = .565). VI-RADS emerged as a key predictor for MIBC in both univariate (OR: 40.3, P < .001) and multivariate (OR: 54.6, P < .001) analyses. Primary tumors with VI-RADS ≥ 3 demonstrated significantly shorter RFS (P = .02) and PFS (P = .04). CONCLUSIONS In conclusion, mpMRI with VI-RADS has a high diagnostic value in predicting MIBC in both primary and recurrent BCa. A VI-RADS threshold ≥ 3 is a strong predictor for MIBC, and in primary tumors predicts early recurrence and progression.
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Affiliation(s)
- Mieszko Kozikowski
- Polish Center of Advanced Urology, Department of Urology, St. Anne's Hospital EMC, Piaseczno, Poland.
- Department of Diagnostic Imaging - Quadia, Piaseczno, Poland.
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland.
- Section of Urologic Oncology of Polish Urological Association, Warsaw, Poland.
| | | | - Marek Zawadzki
- Polish Center of Advanced Urology, Department of Urology, St. Anne's Hospital EMC, Piaseczno, Poland
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland
| | - Przemysław Zugaj
- Polish Center of Advanced Urology, Department of Urology, St. Anne's Hospital EMC, Piaseczno, Poland
| | - Rafał Osiecki
- Urology Clinic of Medical Postgraduate Education Centre, Department of Urology, Independent Public Hospital them. prof. W. Orlowski, Warsaw, Poland
| | | | - Mateusz Śledź
- Department of Diagnostic Imaging - Quadia, Piaseczno, Poland
| | - Roman Sosnowski
- Section of Urologic Oncology of Polish Urological Association, Warsaw, Poland
- Department of Urology and Oncological Urology, Warmian-Masurian Cancer Center, Olsztyn, Poland
| | - Jakub Dobruch
- Urology Clinic of Medical Postgraduate Education Centre, Department of Urology, Independent Public Hospital them. prof. W. Orlowski, Warsaw, Poland
| | - Francesco Del Giudice
- Department of Maternal Infant and Urologic Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Wojciech Krajewski
- Section of Urologic Oncology of Polish Urological Association, Warsaw, Poland
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, Wroclaw, Poland
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Klempfner H, Anderson P. Comparison of staging MRI to re-resection for localised bladder cancer: Narrative review. BJUI COMPASS 2024; 5:651-661. [PMID: 39022656 PMCID: PMC11250143 DOI: 10.1002/bco2.365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/25/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction Bladder cancer (BCa) is characterised by high prevalence, multifocality, and frequent recurrence, imposing significant clinical and economic burdens. Accurate staging, particularly distinguishing non-muscle-invasive bladder cancer (NMIBC) from muscle-invasive bladder cancer (MIBC) disease, is crucial for guiding treatment decisions. This narrative review explores the potential implications of incorporating multiparametric magnetic resonance imaging (mpMRI) and the Vesical Imaging Reporting Data System (VI-RADS) into BCa staging, focusing on repeat transurethral resection of bladder tumour (re-TURBT). Methods A comprehensive search of PubMed, EMBASE, and MEDLINE databases identified studies published from 2018 to 2023 discussing mpMRI or VI-RADS in the context of re-TURBT for BCa staging. Studies meeting inclusion criteria underwent qualitative analysis. Results Six recent studies met inclusion criteria. VI-RADS scoring, accurately predicted muscle invasion, aiding in NMIBC/MIBC differentiation. VI-RADS scores of ≥3 indicated MIBC with high sensitivity and specificity. VI-RADS potentially identified patients benefiting from re-TURBT and those for whom it could be safely omitted. Discussion mpMRI and VI-RADS offer promising prospects for BCa staging, potentially correlating more closely with re-TURBT and radical cystectomy histopathology than initial TURBT. However, validation and careful evaluation of clinical integration are needed. Future research should refine patient selection and optimise mpMRI's role in BCa management. Conclusion VI-RADS scoring could revolutionise BCa staging, especially regarding re-TURBT. There is potential that VI-RADS correlates more with the histopathology of re-TURBT and radical cystectomy than initial TURBT. While promising, ongoing research is essential to validate utility, refine selection criteria, and address economic considerations. Integration of VI-RADS into BCa staging holds potential benefits for patients and health care systems.
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Affiliation(s)
- Hugo Klempfner
- Department of Medicine, Melbourne Health and Northern HealthThe University of Melbourne VictoriaMelbourneAustralia
| | - Paul Anderson
- Department of UrologyRoyal Melbourne HospitalMelbourneAustralia
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Gumus KZ, Nicolas J, Gopireddy DR, Dolz J, Jazayeri SB, Bandyk M. Deep Learning Algorithms for Bladder Cancer Segmentation on Multi-Parametric MRI. Cancers (Basel) 2024; 16:2348. [PMID: 39001410 PMCID: PMC11240435 DOI: 10.3390/cancers16132348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 06/18/2024] [Accepted: 06/25/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Bladder cancer (BC) segmentation on MRI images is the first step to determining the presence of muscular invasion. This study aimed to assess the tumor segmentation performance of three deep learning (DL) models on multi-parametric MRI (mp-MRI) images. METHODS We studied 53 patients with bladder cancer. Bladder tumors were segmented on each slice of T2-weighted (T2WI), diffusion-weighted imaging/apparent diffusion coefficient (DWI/ADC), and T1-weighted contrast-enhanced (T1WI) images acquired at a 3Tesla MRI scanner. We trained Unet, MAnet, and PSPnet using three loss functions: cross-entropy (CE), dice similarity coefficient loss (DSC), and focal loss (FL). We evaluated the model performances using DSC, Hausdorff distance (HD), and expected calibration error (ECE). RESULTS The MAnet algorithm with the CE+DSC loss function gave the highest DSC values on the ADC, T2WI, and T1WI images. PSPnet with CE+DSC obtained the smallest HDs on the ADC, T2WI, and T1WI images. The segmentation accuracy overall was better on the ADC and T1WI than on the T2WI. The ECEs were the smallest for PSPnet with FL on the ADC images, while they were the smallest for MAnet with CE+DSC on the T2WI and T1WI. CONCLUSIONS Compared to Unet, MAnet and PSPnet with a hybrid CE+DSC loss function displayed better performances in BC segmentation depending on the choice of the evaluation metric.
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Affiliation(s)
- Kazim Z. Gumus
- Department of Radiology, College of Medicine-Jacksonville, University of Florida, Jacksonville, FL 32209, USA
| | - Julien Nicolas
- Laboratory for Imagery, Vision and Artificial Intelligence, ETS Montreal, Montreal, QC H3C 1K3, Canada
| | - Dheeraj R. Gopireddy
- Department of Radiology, College of Medicine-Jacksonville, University of Florida, Jacksonville, FL 32209, USA
| | - Jose Dolz
- Laboratory for Imagery, Vision and Artificial Intelligence, ETS Montreal, Montreal, QC H3C 1K3, Canada
| | - Seyed Behzad Jazayeri
- Department of Urology, College of Medicine-Jacksonville, University of Florida, Jacksonville, FL 32209, USA (M.B.)
| | - Mark Bandyk
- Department of Urology, College of Medicine-Jacksonville, University of Florida, Jacksonville, FL 32209, USA (M.B.)
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Hoffmann E, Masthoff M, Kunz WG, Seidensticker M, Bobe S, Gerwing M, Berdel WE, Schliemann C, Faber C, Wildgruber M. Multiparametric MRI for characterization of the tumour microenvironment. Nat Rev Clin Oncol 2024; 21:428-448. [PMID: 38641651 DOI: 10.1038/s41571-024-00891-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 04/21/2024]
Abstract
Our understanding of tumour biology has evolved over the past decades and cancer is now viewed as a complex ecosystem with interactions between various cellular and non-cellular components within the tumour microenvironment (TME) at multiple scales. However, morphological imaging remains the mainstay of tumour staging and assessment of response to therapy, and the characterization of the TME with non-invasive imaging has not yet entered routine clinical practice. By combining multiple MRI sequences, each providing different but complementary information about the TME, multiparametric MRI (mpMRI) enables non-invasive assessment of molecular and cellular features within the TME, including their spatial and temporal heterogeneity. With an increasing number of advanced MRI techniques bridging the gap between preclinical and clinical applications, mpMRI could ultimately guide the selection of treatment approaches, precisely tailored to each individual patient, tumour and therapeutic modality. In this Review, we describe the evolving role of mpMRI in the non-invasive characterization of the TME, outline its applications for cancer detection, staging and assessment of response to therapy, and discuss considerations and challenges for its use in future medical applications, including personalized integrated diagnostics.
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Affiliation(s)
- Emily Hoffmann
- Clinic of Radiology, University of Münster, Münster, Germany
| | - Max Masthoff
- Clinic of Radiology, University of Münster, Münster, Germany
| | - Wolfgang G Kunz
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Stefanie Bobe
- Gerhard Domagk Institute of Pathology, University Hospital Münster, Münster, Germany
| | - Mirjam Gerwing
- Clinic of Radiology, University of Münster, Münster, Germany
| | | | | | - Cornelius Faber
- Clinic of Radiology, University of Münster, Münster, Germany
| | - Moritz Wildgruber
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany.
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Tiwari P, Yadav A, Kaushik M, Dada R. Cancer risk and male Infertility: Unravelling predictive biomarkers and prognostic indicators. Clin Chim Acta 2024; 558:119670. [PMID: 38614420 DOI: 10.1016/j.cca.2024.119670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 04/15/2024]
Abstract
In recent years, there has been a global increase in cases of male infertility. There are about 30 million cases of male infertility worldwide and male reproductive health is showing rapid decline in last few decades. It is now recognized as a potential risk factor for developing certain types of cancer, particularly genitourinary malignancies like testicular and prostate cancer. Male infertility is considered a potential indicator of overall health and an early biomarker for cancer. Cases of unexplained male factor infertility have high levels of oxidative stress and oxidative DNA damage and this induces both denovo germ line mutations and epimutations due to build up of 8-hydroxy 2 deoxygunaosine abase which is highly mutagenic and also induces hypomethylation and genomic instability. Consequently, there is growing evidence to explore the various factors contributing to an increased cancer risk. Currently, the available prognostic and predictive biomarkers associated with semen characteristics and cancer risk are limited but gaining significant attention in clinical research for the diagnosis and treatment of elevated cancer risk in the individual and in offspring. The male germ cell being transcriptionally and translationally inert has a highly truncated repair mechanism and has minimal antioxidants and thus most vulnerable to oxidative injury due to environmental factors and unhealthy lifestyle and social habits. Therefore, advancing our understanding requires a thorough evaluation of the pathophysiologic mechanisms at the DNA, RNA, protein, and metabolite levels to identify key biomarkers that may underlie the pathogenesis of male infertility and associated cancer. Advanced methodologies such as genomics, epigenetics, proteomics, transcriptomics, and metabolomics stand at the forefront of cutting-edge approaches for discovering novel biomarkers, spanning from infertility to associated cancer types. Henceforth, in this review, we aim to assess the role and potential of recently identified predictive and prognostic biomarkers, offering insights into the success of assisted reproductive technologies, causes of azoospermia and idiopathic infertility, the impact of integrated holistic approach and lifestyle modifications, and the monitoring of cancer susceptibility, initiation and progression. Comprehending these biomarkers is crucial for providing comprehensive counselling to infertile men and cancer patients, along with their families.
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Affiliation(s)
- Prabhakar Tiwari
- Lab for Molecular Reproduction and Genetics, Department of Anatomy, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India.
| | - Anjali Yadav
- Lab for Molecular Reproduction and Genetics, Department of Anatomy, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - Meenakshi Kaushik
- Lab for Molecular Reproduction and Genetics, Department of Anatomy, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - Rima Dada
- Lab for Molecular Reproduction and Genetics, Department of Anatomy, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India.
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Cao B, Li Q, Xu P, Zhang Y, Cai S, Rao S, Zeng M, Dai Y, Jiang S, Zhou J. Vesical Imaging-Reporting and Data System (VI-RADS) as a grouping imaging biomarker combined with a decision-tree mode to preoperatively predict the pathological grade of bladder cancer. Clin Radiol 2024; 79:e725-e735. [PMID: 38360514 DOI: 10.1016/j.crad.2024.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/12/2024] [Accepted: 01/22/2024] [Indexed: 02/17/2024]
Abstract
AIM To investigate whether the Vesical Imaging-Reporting and Data System (VI-RADS) could be used to develop a new non-invasive preoperative grade-prediction system to partially predict high-grade bladder cancer (HG-BC). MATERIALS AND METHODS The present study enrolled 89 primary BC patients prospectively from March 2022 to June 2023. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of VI-RADS for predicting HG-BC and muscle-invasive bladder cancer (MIBC) in the entire group. In the low VI-RADS (≤2) group, the decision tree-based method was used to obtain significant predictors and construct the decision-tree model (DT model). The performance of the DT model and low VI-RADS scores for predicting HG-BC was determined using ROC, calibration, and decision curve analyses. RESULTS At a cut-off of ≥3, the specificity and positive predictive value of VI-RADS for predicting HG-BC in the entire group was 100%, and the area under the ROC curve (AUC) was 0.697. Among 65 patients with low VI-RADS scores, the DT model showed an AUC of 0.884 in predicting HG-BC compared to 0.506 for low VI-RADS scores. Calibration and decision curve analyses showed that the DT model performed better than the low VI-RADS scores. CONCLUSION Most VI-RADS scores ≥3 correspond to HG-BCs. VI-RADS could be used as a grouping imaging biomarker for a pathological grade-prediction procedure, which in combination with the DT model for low VI-RADS (≤2) populations, would provide a potential preoperative non-invasive method of predicting HG-BC.
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Affiliation(s)
- B Cao
- Department of Radiology, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Radiology, Shanghai Geriatric Medical Center, Shanghai, China
| | - Q Li
- Department of Radiology, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China
| | - P Xu
- Department of Urology, Xuhui Hospital, Fudan University, Shanghai, China
| | - Y Zhang
- MR Collaboration, Central Research Institute, United Imaging Healthcare, Shanghai, China
| | - S Cai
- Department of Radiology, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China
| | - S Rao
- Department of Radiology, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Radiology, Shanghai Geriatric Medical Center, Shanghai, China
| | - M Zeng
- Department of Radiology, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Radiology, Shanghai Geriatric Medical Center, Shanghai, China
| | - Y Dai
- MR Collaboration, Central Research Institute, United Imaging Healthcare, Shanghai, China
| | - S Jiang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Urology, Zhongshan Hospital Wusong Branch, Fudan University, Shanghai, China.
| | - J Zhou
- Department of Radiology, Fudan University Zhongshan Hospital Xiamen Branch, Xiamen, China; Xiamen Municipal Clinical Research Center for Medical Imaging, Xiamen, China; Xiamen Key Clinical Specialty for Radiology, Xiamen, China.
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Chai JL, Roller LA, Liu X, Lan Z, Mossanen M, Silverman SG, Shinagare AB. Performance of VI-RADS in predicting muscle-invasive bladder cancer after transurethral resection: a single center retrospective analysis. Abdom Radiol (NY) 2024; 49:1593-1602. [PMID: 38502214 DOI: 10.1007/s00261-024-04245-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE To assess VIRADS performance and inter-reader agreement for detecting muscle-invasive bladder cancer (MIBC) following transurethral resection of bladder tumor (TURBT). METHODS An IRB-approved, HIPAA-compliant, retrospective study from 2016 to 2020 included patients with bladder urothelial carcinoma who underwent MRI after TURBT, and cystectomy within 3 months without post-MRI treatments. Three radiologists blinded to pathology results independently reviewed MR images and assigned a VI-RADS score. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of VI-RADS were assessed for diagnosing MIBC using VI-RADS scores ≥ 3 and ≥ 4. Inter-reader agreement was assessed using Gwet's agreement coefficient (AC) and percent agreement. RESULTS The cohort consisted of 70 patients (mean age, 68 years ± 11 [SD]; range 39-85; 58 men) and included 32/70 (46%) with MIBC at cystectomy. ROC analysis revealed an AUC ranging from 0.67 to 0.77 and no pairwise statistical difference between readers (p-values, 0.06, 0.08, 0.97). Percent sensitivity, specificity, PPV, NPV and accuracy for diagnosing MIBC for the three readers ranged from 81.3-93.8, 36.8-55.3, 55.6-60.5, 77.3-87.5, and 62.9-67.1 respectively for VI-RADS score ≥ 3, and 78.1-81.3, 47.4-68.4, 55.6-67.6, 72.0-78.8 and 61.4-72.9 respectively for VI-RADS score ≥ 4. Gwet's AC was 0.63 [95% confidence interval (CI): 0.49,0.78] for VI-RADS score ≥ 3 with 79% agreement [95% CI 72,87] and 0.54 [95%CI 0.38,0.70] for VI-RADS score ≥ 4 with 76% agreement [95% CI 69,84]. VIRADS performance was not statistically different among 31/70 (44%) patients who received treatments prior to MRI (p ≥ 0.16). CONCLUSION VI-RADS had moderate sensitivity and accuracy but low specificity for detection of MIBC following TURBT, with moderate inter-reader agreement.
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Affiliation(s)
- Jessie L Chai
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
| | - Lauren A Roller
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Xiaoyang Liu
- Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, University of Toronto, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - Zhou Lan
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Matthew Mossanen
- Department of Urology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Stuart G Silverman
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Atul B Shinagare
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
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Zhang X, Wang Y, Wang Y, Zhang J, Zhang J, Zhang L, Wang S, Shou J, Chen Y, Zhao X. MRI evaluation of vesical imaging reporting and data system for bladder cancer after neoadjuvant chemotherapy. Cancer Imaging 2024; 24:49. [PMID: 38584289 PMCID: PMC11000365 DOI: 10.1186/s40644-024-00696-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 03/29/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND The Vesical Imaging-Reporting and Data System (VI-RADS) has demonstrated effectiveness in predicting muscle invasion in bladder cancer before treatment. The urgent need currently is to evaluate the muscle invasion status after neoadjuvant chemotherapy (NAC) for bladder cancer. This study aims to ascertain the accuracy of VI-RADS in detecting muscle invasion post-NAC treatment and assess its diagnostic performance across readers with varying experience levels. METHODS In this retrospective study, patients with muscle-invasive bladder cancer who underwent magnetic resonance imaging (MRI) after NAC from September 2015 to September 2018 were included. VI-RADS scores were independently assessed by five radiologists, consisting of three experienced in bladder MRI and two inexperienced radiologists. Comparison of VI-RADS scores was made with postoperative histopathological diagnosis. Receiver operating characteristic curve analysis (ROC) was used for evaluating diagnostic performance, calculating sensitivity, specificity, and area under ROC (AUC)). Interobserver agreement was assessed using the weighted kappa statistic. RESULTS The final analysis included 46 patients (mean age: 61 years ± 9 [standard deviation]; age range: 39-70 years; 42 men). The pooled AUC for predicting muscle invasion was 0.945 (95% confidence interval (CI): 0.893-0.977) for experienced readers, and 0.910 (95% CI: 0.831-0.959) for inexperienced readers, and 0.932 (95% CI: 0.892-0.961) for all readers. At an optimal cut-off value ≥ 4, pooled sensitivity and specificity were 74.1% (range: 66.0-80.9%) and 94.1% (range: 88.6-97.7%) for experienced readers, and 63.9% (range: 59.6-68.1%) and 86.4% (range: 84.1-88.6%) for inexperienced readers. Interobserver agreement ranged from substantial to excellent between all readers (k = 0.79-0.92). CONCLUSIONS VI-RADS accurately assesses muscle invasion in bladder cancer patients after NAC and exhibits good diagnostic performance across readers with different experience levels.
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Affiliation(s)
- Xinxin Zhang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Yichen Wang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Yilin Wang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Jie Zhang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Jin Zhang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Lianyu Zhang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Sicong Wang
- GE Healthcare, MR Research China, Beijing, 100176, China
| | - Jianzhong Shou
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
| | - Yan Chen
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
| | - Xinming Zhao
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
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11
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Panebianco V, Briganti A, Boellaard TN, Catto J, Comperat E, Efstathiou J, van der Heijden AG, Giannarini G, Girometti R, Mertens L, Takeuchi M, Muglia VF, Narumi Y, Novara G, Pecoraro M, Roupret M, Sanguedolce F, Santini D, Shariat SF, Simone G, Vargas HA, Woo S, Barentsz J, Witjes JA. Clinical application of bladder MRI and the Vesical Imaging-Reporting and Data System. Nat Rev Urol 2024; 21:243-251. [PMID: 38036666 DOI: 10.1038/s41585-023-00830-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 12/02/2023]
Abstract
Diagnostic work-up and risk stratification in patients with bladder cancer before and after treatment must be refined to optimize management and improve outcomes. MRI has been suggested as a non-invasive technique for bladder cancer staging and assessment of response to systemic therapy. The Vesical Imaging-Reporting And Data System (VI-RADS) was developed to standardize bladder MRI image acquisition, interpretation and reporting and enables accurate prediction of muscle-wall invasion of bladder cancer. MRI is available in many centres but is not yet recommended as a first-line test for bladder cancer owing to a lack of high-quality evidence. Consensus-based evidence on the use of MRI-VI-RADS for bladder cancer care is needed to serve as a benchmark for formulating guidelines and research agendas until further evidence from randomized trials becomes available.
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Affiliation(s)
- Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy.
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Thierry N Boellaard
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - James Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Eva Comperat
- Department of Pathology, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Hopital Tenon, Paris, France
| | - Jason Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Gianluca Giannarini
- Urology Unit, Academic Medical Centre "Santa Maria della Misericordia", Udine, Italy
| | - Rossano Girometti
- Institute of Radiology, Academic Medical Centre "Santa Maria della Misericordia", Udine, Italy
| | - Laura Mertens
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Valdair F Muglia
- Department of Medical Images, Radiation Therapy and Oncohematology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | | | - Giacomo Novara
- Department of Surgery, Oncology, and Gastroenterology - Urology Clinic, University of Padua, Padua, Italy
| | - Martina Pecoraro
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Morgan Roupret
- Department of Urology, Sorbonne University, AP-HP, Pitié Salpétrière Hospital, Paris, France
| | - Francesco Sanguedolce
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Daniele Santini
- Division of Medical Oncology A, Policlinico Umberto I, Rome, Italy
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
| | - Shahrokh F Shariat
- Department of Urology, Teaching Hospital Motol and 2nd Faculty of Medicine, Charles University Praha, Prague, Czech Republic
- Department of Urology, Comprehensive Cancer Center, Medical University Vienna, Vienna General Hospital, Vienna, Austria
| | - Giuseppe Simone
- IRCCS "Regina Elena" National Cancer Institute, Department of Urology, Rome, Italy
| | - Hebert A Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jelle Barentsz
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands
| | - J Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
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12
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Cai L, Yu R, Liu P, Zhuang J, Li K, Wu Q, Sun X, Liu Y, Zhou M, Cao Q, Li P, Yang X, Lu Q. A Nomogram of MRI Features to Assess Muscle Invasion in VI-RADS 2 Tumors With Stalk. J Magn Reson Imaging 2024; 59:1179-1190. [PMID: 37602726 DOI: 10.1002/jmri.28924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 07/12/2023] [Accepted: 07/12/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Vesical Imaging-Reporting and Data System (VI-RADS) is widely used to assess the muscle-invasive status of bladder cancer. However, the current classification efficacy of VI-RASD 2 tumors of stalk is unsatisfactory. PURPOSE To develop a nomogram to assess muscle-invasive bladder cancer (MIBC) in VI-RADS 2 tumors with stalk. STUDY TYPE Retrospective. POPULATION A total of 186 patients (age: 67.8 ± 12.7 years) with 15.1% females, divided randomly into a training cohort (N = 130) and validation cohort (N = 56). FIELD STRENGTH/SEQUENCE 3-T, T2-weighted imaging (turbo spin-echo), diffusion-weighted imaging (breathing-free spin-echo), and dynamic contrast-enhanced imaging (gradient-echo). ASSESSMENT Twenty-one MRI features of tumors and stalks were developed from training cohort. The mean apparent diffusion coefficient (ADC) values of the tumor, stalk, and psoas muscles were calculated from the three circular regions of interest. The normalized T value = mean ADC tumor mean ADC muscle . The normalized ST value = mean ADC stalk mean ADC tumor . Three readers assessed the morphology of tumors and stalks. STATISTICAL TESTS The final features of nomogram were selected by univariable logistic and the least absolute shrinkage and selection operator (LASSO) regression. The performance of the nomogram was assessed by the receiver operating characteristic (ROC) curve, calibration, and decision curve analysis. RESULTS In VI-RADS 2 tumors with stalk, tumor size over 3 cm, increased stalk width, stalk morphology, decreased normalized T value, and increased normalized ST value were selected as the risk factors for MIBC. The AUC, accuracy, sensitivity, and specificity of the nomogram to assess MIBC were 0.969 (95% CI: 0.941-0.997), 92.3%, 94.1%, and 92.0% in training cohort and 0.940 (95% CI: 0.859-1.000), 89.3%, 75.0%, and 91.7% in validation cohort. DATA CONCLUSION This study constructed a nomogram for preoperative assessment of MIBC and modifying the current VI-RADS. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Lingkai Cai
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Department of Urology, Wuxi Medical Center of Nanjing Medical University, Wuxi, China
| | - Ruixi Yu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Peikun Liu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Juntao Zhuang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kai Li
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qikai Wu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xueying Sun
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yang Liu
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ming Zhou
- Department of Urology, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Qiang Cao
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Pengchao Li
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiao Yang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qiang Lu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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13
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Yang G, Bai J, Hao M, Zhang L, Fan Z, Wang X. Enhancing recurrence risk prediction for bladder cancer using multi-sequence MRI radiomics. Insights Imaging 2024; 15:88. [PMID: 38526620 DOI: 10.1186/s13244-024-01662-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/04/2024] [Indexed: 03/27/2024] Open
Abstract
OBJECTIVE We aimed to develop a radiomics-clinical nomogram using multi-sequence MRI to predict recurrence-free survival (RFS) in bladder cancer (BCa) patients and assess its superiority over clinical models. METHODS A retrospective cohort of 229 BCa patients with preoperative multi-sequence MRI was divided into a training set (n = 160) and a validation set (n = 69). Radiomics features were extracted from T2-weighted images, diffusion-weighted imaging, apparent diffusion coefficient, and dynamic contrast-enhanced images. Effective features were identified using the least absolute shrinkage and selection operator (LASSO) method. Clinical risk factors were determined via univariate and multivariate Cox analysis, leading to the creation of a radiomics-clinical nomogram. Kaplan-Meier analysis and log-rank tests assessed the relationship between radiomics features and RFS. We calculated the net reclassification improvement (NRI) to evaluate the added value of the radiomics signature and used decision curve analysis (DCA) to assess the nomogram's clinical validity. RESULTS Radiomics features significantly correlated with RFS (log-rank p < 0.001) and were independent of clinical factors (p < 0.001). The combined model, incorporating radiomics features and clinical data, demonstrated the best prognostic value, with C-index values of 0.853 in the training set and 0.832 in the validation set. Compared to the clinical model, the radiomics-clinical nomogram exhibited superior calibration and classification (NRI: 0.6768, 95% CI: 0.5549-0.7987, p < 0.001). CONCLUSION The radiomics-clinical nomogram, based on multi-sequence MRI, effectively assesses the BCa recurrence risk. It outperforms both the radiomics model and the clinical model in predicting BCa recurrence risk. CRITICAL RELEVANCE STATEMENT The radiomics-clinical nomogram, utilizing multi-sequence MRI, holds promise for predicting bladder cancer recurrence, enhancing individualized clinical treatment, and performing tumor surveillance. KEY POINTS • Radiomics plays a vital role in predicting bladder cancer recurrence. • Precise prediction of tumor recurrence risk is crucial for clinical management. • MRI-based radiomics models excel in predicting bladder cancer recurrence.
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Affiliation(s)
- Guoqiang Yang
- Department of Radiology, the First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jingjing Bai
- Department of Radiology, the First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- College of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Min Hao
- Department of Radiology, the First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- College of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Lu Zhang
- Department of Radiology, the First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- College of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Zhichang Fan
- Department of Radiology, the First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- College of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xiaochun Wang
- Department of Radiology, the First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.
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Fávero Prietto Dos Santos J, Ghezzi CLA, Pedrollo IM, Cruz ÍR, Orozco OFG, Zapparoli M, Schuch A, Muglia VF. Practical Guide to VI-RADS: MRI Protocols, Lesion Characterization, and Pitfalls. Radiographics 2024; 44:e230149. [PMID: 38421912 DOI: 10.1148/rg.230149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Urothelial carcinoma is the most common type of bladder cancer (BC), accounting for approximately 90% of all cases. Evaluating the depth of tumor invasion in the bladder wall (tumor staging) is essential for determining the treatment and prognosis in patients with BC. Neoadjuvant therapy followed by radical cystectomy is the most common treatment of localized muscle-invasive BC (MIBC). Therefore, it is vital to differentiate non-MIBC from MIBC. Transurethral resection of bladder tumor (TURBT) is the reference standard to determine the extent of tumor invasion into the bladder wall through tissue sampling. However, this diagnostic and therapeutic method may not adequately sample the muscularis propria, leading to a higher risk of residual disease, early recurrence, and tumor understaging in approximately 50% of patients during the initial TURBT. Multiparametric MRI can overcome some of the limitations of TURBT when evaluating BC, particularly regarding tumor staging. In this context, the Vesical Imaging Reporting and Data System (VI-RADS) classification was developed to establish standards for bladder multiparametric MRI and interpretation. It uses a 5-point scale to assess the likelihood of detrusor muscle invasion. T2-weighted MR images are particularly useful as an initial guide, especially for categories 1-3, while the presence of muscular invasion is determined with diffusion-weighted and dynamic contrast-enhanced sequences. Diffusion-weighted imaging takes precedence as the dominant method when optimal image quality is achieved. The presence of a stalk or a thickened inner layer and no evidence of interruption of the signal intensity of the muscular layer are central for predicting a low likelihood of muscle invasion. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material. See the invited commentary by Hoegger in this issue.
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Affiliation(s)
- Jônatas Fávero Prietto Dos Santos
- From the Department of Radiology, Division of Body Imaging, Hospital Moinhos de Vento, 910 Ramiro Barcelos St, Porto Alegre, RS 90035-000, Brazil, and Program in Pneumology Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (J.F.P.d.S.); Department of Radiology, Division of Abdominal Imaging, Hospital Moinhos de Vento, Porto Alegre, Brazil (C.L.A.G., I.M.P., A.S.); Department of Radiology, Division of Abdominal Imaging, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (C.L.A.G., I.M.P); Department of Radiology, Division of Abdominal Imaging, Hospital da Restauração, Recife, Brazil, Centro de Diagnóstico Boris Berenstein, Recife, Brazil, and Department of Radiology, Division of Abdominal Imaging, Hospital Santa Joana, Recife, Brazil (I.R.C.); Division of Abdominal Imaging, Diagnóstico Avançado por Imagem (DAPI), Curitiba, Brazil, and Department of Internal Medicine, Division of Abdominal Imaging, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil (O.F.G.O., M.Z.); and Department of Radiology, Oncology and Hematology, Division of Abdominal Imaging, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil (V.F.M.)
| | - Caroline Lorenzoni Almeida Ghezzi
- From the Department of Radiology, Division of Body Imaging, Hospital Moinhos de Vento, 910 Ramiro Barcelos St, Porto Alegre, RS 90035-000, Brazil, and Program in Pneumology Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (J.F.P.d.S.); Department of Radiology, Division of Abdominal Imaging, Hospital Moinhos de Vento, Porto Alegre, Brazil (C.L.A.G., I.M.P., A.S.); Department of Radiology, Division of Abdominal Imaging, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (C.L.A.G., I.M.P); Department of Radiology, Division of Abdominal Imaging, Hospital da Restauração, Recife, Brazil, Centro de Diagnóstico Boris Berenstein, Recife, Brazil, and Department of Radiology, Division of Abdominal Imaging, Hospital Santa Joana, Recife, Brazil (I.R.C.); Division of Abdominal Imaging, Diagnóstico Avançado por Imagem (DAPI), Curitiba, Brazil, and Department of Internal Medicine, Division of Abdominal Imaging, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil (O.F.G.O., M.Z.); and Department of Radiology, Oncology and Hematology, Division of Abdominal Imaging, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil (V.F.M.)
| | - Ivan Morzoletto Pedrollo
- From the Department of Radiology, Division of Body Imaging, Hospital Moinhos de Vento, 910 Ramiro Barcelos St, Porto Alegre, RS 90035-000, Brazil, and Program in Pneumology Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (J.F.P.d.S.); Department of Radiology, Division of Abdominal Imaging, Hospital Moinhos de Vento, Porto Alegre, Brazil (C.L.A.G., I.M.P., A.S.); Department of Radiology, Division of Abdominal Imaging, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (C.L.A.G., I.M.P); Department of Radiology, Division of Abdominal Imaging, Hospital da Restauração, Recife, Brazil, Centro de Diagnóstico Boris Berenstein, Recife, Brazil, and Department of Radiology, Division of Abdominal Imaging, Hospital Santa Joana, Recife, Brazil (I.R.C.); Division of Abdominal Imaging, Diagnóstico Avançado por Imagem (DAPI), Curitiba, Brazil, and Department of Internal Medicine, Division of Abdominal Imaging, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil (O.F.G.O., M.Z.); and Department of Radiology, Oncology and Hematology, Division of Abdominal Imaging, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil (V.F.M.)
| | - Ítalo Ribeiro Cruz
- From the Department of Radiology, Division of Body Imaging, Hospital Moinhos de Vento, 910 Ramiro Barcelos St, Porto Alegre, RS 90035-000, Brazil, and Program in Pneumology Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (J.F.P.d.S.); Department of Radiology, Division of Abdominal Imaging, Hospital Moinhos de Vento, Porto Alegre, Brazil (C.L.A.G., I.M.P., A.S.); Department of Radiology, Division of Abdominal Imaging, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (C.L.A.G., I.M.P); Department of Radiology, Division of Abdominal Imaging, Hospital da Restauração, Recife, Brazil, Centro de Diagnóstico Boris Berenstein, Recife, Brazil, and Department of Radiology, Division of Abdominal Imaging, Hospital Santa Joana, Recife, Brazil (I.R.C.); Division of Abdominal Imaging, Diagnóstico Avançado por Imagem (DAPI), Curitiba, Brazil, and Department of Internal Medicine, Division of Abdominal Imaging, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil (O.F.G.O., M.Z.); and Department of Radiology, Oncology and Hematology, Division of Abdominal Imaging, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil (V.F.M.)
| | - Oscar Fernando Ghattas Orozco
- From the Department of Radiology, Division of Body Imaging, Hospital Moinhos de Vento, 910 Ramiro Barcelos St, Porto Alegre, RS 90035-000, Brazil, and Program in Pneumology Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (J.F.P.d.S.); Department of Radiology, Division of Abdominal Imaging, Hospital Moinhos de Vento, Porto Alegre, Brazil (C.L.A.G., I.M.P., A.S.); Department of Radiology, Division of Abdominal Imaging, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (C.L.A.G., I.M.P); Department of Radiology, Division of Abdominal Imaging, Hospital da Restauração, Recife, Brazil, Centro de Diagnóstico Boris Berenstein, Recife, Brazil, and Department of Radiology, Division of Abdominal Imaging, Hospital Santa Joana, Recife, Brazil (I.R.C.); Division of Abdominal Imaging, Diagnóstico Avançado por Imagem (DAPI), Curitiba, Brazil, and Department of Internal Medicine, Division of Abdominal Imaging, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil (O.F.G.O., M.Z.); and Department of Radiology, Oncology and Hematology, Division of Abdominal Imaging, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil (V.F.M.)
| | - Maurício Zapparoli
- From the Department of Radiology, Division of Body Imaging, Hospital Moinhos de Vento, 910 Ramiro Barcelos St, Porto Alegre, RS 90035-000, Brazil, and Program in Pneumology Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (J.F.P.d.S.); Department of Radiology, Division of Abdominal Imaging, Hospital Moinhos de Vento, Porto Alegre, Brazil (C.L.A.G., I.M.P., A.S.); Department of Radiology, Division of Abdominal Imaging, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (C.L.A.G., I.M.P); Department of Radiology, Division of Abdominal Imaging, Hospital da Restauração, Recife, Brazil, Centro de Diagnóstico Boris Berenstein, Recife, Brazil, and Department of Radiology, Division of Abdominal Imaging, Hospital Santa Joana, Recife, Brazil (I.R.C.); Division of Abdominal Imaging, Diagnóstico Avançado por Imagem (DAPI), Curitiba, Brazil, and Department of Internal Medicine, Division of Abdominal Imaging, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil (O.F.G.O., M.Z.); and Department of Radiology, Oncology and Hematology, Division of Abdominal Imaging, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil (V.F.M.)
| | - Alice Schuch
- From the Department of Radiology, Division of Body Imaging, Hospital Moinhos de Vento, 910 Ramiro Barcelos St, Porto Alegre, RS 90035-000, Brazil, and Program in Pneumology Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (J.F.P.d.S.); Department of Radiology, Division of Abdominal Imaging, Hospital Moinhos de Vento, Porto Alegre, Brazil (C.L.A.G., I.M.P., A.S.); Department of Radiology, Division of Abdominal Imaging, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (C.L.A.G., I.M.P); Department of Radiology, Division of Abdominal Imaging, Hospital da Restauração, Recife, Brazil, Centro de Diagnóstico Boris Berenstein, Recife, Brazil, and Department of Radiology, Division of Abdominal Imaging, Hospital Santa Joana, Recife, Brazil (I.R.C.); Division of Abdominal Imaging, Diagnóstico Avançado por Imagem (DAPI), Curitiba, Brazil, and Department of Internal Medicine, Division of Abdominal Imaging, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil (O.F.G.O., M.Z.); and Department of Radiology, Oncology and Hematology, Division of Abdominal Imaging, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil (V.F.M.)
| | - Valdair Francisco Muglia
- From the Department of Radiology, Division of Body Imaging, Hospital Moinhos de Vento, 910 Ramiro Barcelos St, Porto Alegre, RS 90035-000, Brazil, and Program in Pneumology Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (J.F.P.d.S.); Department of Radiology, Division of Abdominal Imaging, Hospital Moinhos de Vento, Porto Alegre, Brazil (C.L.A.G., I.M.P., A.S.); Department of Radiology, Division of Abdominal Imaging, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (C.L.A.G., I.M.P); Department of Radiology, Division of Abdominal Imaging, Hospital da Restauração, Recife, Brazil, Centro de Diagnóstico Boris Berenstein, Recife, Brazil, and Department of Radiology, Division of Abdominal Imaging, Hospital Santa Joana, Recife, Brazil (I.R.C.); Division of Abdominal Imaging, Diagnóstico Avançado por Imagem (DAPI), Curitiba, Brazil, and Department of Internal Medicine, Division of Abdominal Imaging, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil (O.F.G.O., M.Z.); and Department of Radiology, Oncology and Hematology, Division of Abdominal Imaging, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil (V.F.M.)
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Yu J, Cai L, Chen C, Zou Y, Xiao Y, Fu X, Wang L, Yang X, Liu P, Lu Q, Sun X, Shao Q. A novel predict method for muscular invasion of bladder cancer based on 3D mp-MRI feature fusion. Phys Med Biol 2024; 69:055011. [PMID: 38306973 DOI: 10.1088/1361-6560/ad25c7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 02/01/2024] [Indexed: 02/04/2024]
Abstract
Objective. To assist urologist and radiologist in the preoperative diagnosis of non-muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC), we proposed a combination models strategy (CMS) utilizing multiparametric magnetic resonance imaging.Approach. The CMS includes three components: image registration, image segmentation, and multisequence feature fusion. To ensure spatial structure consistency of T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and dynamic contrast-enhanced imaging (DCE), a registration network based on patch sampling normalized mutual information was proposed to register DWI and DCE to T2WI. Moreover, to remove redundant information around the bladder, we employed a segmentation network to obtain the bladder and tumor regions from T2WI. Using the coordinate mapping from T2WI, we extracted these regions from DWI and DCE and integrated them into a three-branch dual-channel input. Finally, to fully fuse low-level and high-level features of T2WI, DWI, and DCE, we proposed a distributed multilayer fusion model for preoperative MIBC prediction with five-fold cross-validation.Main results. The study included 436 patients, of which 404 were for the internal cohort and 32 for external cohort. The MIBC was confirmed by pathological examination. In the internal cohort, the area under the curve, accuracy, sensitivity, and specificity achieved by our method were 0.928, 0.869, 0.753, and 0.929, respectively. For the urologist and radiologist, Vesical Imaging-Reporting and Data System score >3 was employed to determine MIBC. The urologist demonstrated an accuracy, sensitivity, and specificity of 0.842, 0.737, and 0.895, respectively, while the radiologist achieved 0.871, 0.803, and 0.906, respectively. In the external cohort, the accuracy of our method was 0.831, which was higher than that of the urologist (0.781) and the radiologist (0.813).Significance. Our proposed method achieved better diagnostic performance than urologist and was comparable to senior radiologist. These results indicate that CMS can effectively assist junior urologists and radiologists in diagnosing preoperative MIBC.
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Affiliation(s)
- Jie Yu
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, People's Republic of China
| | - Lingkai Cai
- Department of Urology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, People's Republic of China
| | - Chunxiao Chen
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, People's Republic of China
| | - Yuan Zou
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, People's Republic of China
| | - Yueyue Xiao
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, People's Republic of China
| | - Xue Fu
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, People's Republic of China
| | - Liang Wang
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, People's Republic of China
| | - Xiao Yang
- Department of Urology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, People's Republic of China
| | - Peikun Liu
- Department of Urology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, People's Republic of China
| | - Qiang Lu
- Department of Urology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, People's Republic of China
| | - Xueying Sun
- Department of Radiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, People's Republic of China
| | - Qiang Shao
- Department of Urology, the Affiliated Suzhou Hospital of Nanjing Medical University, People's Republic of China
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16
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He K, Meng X, Wang Y, Feng C, Liu Z, Li Z, Niu Y. Progress of Multiparameter Magnetic Resonance Imaging in Bladder Cancer: A Comprehensive Literature Review. Diagnostics (Basel) 2024; 14:442. [PMID: 38396481 PMCID: PMC10888296 DOI: 10.3390/diagnostics14040442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/25/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024] Open
Abstract
Magnetic resonance imaging (MRI) has been proven to be an indispensable imaging method in bladder cancer, and it can accurately identify muscular invasion of bladder cancer. Multiparameter MRI is a promising tool widely used for preoperative staging evaluation of bladder cancer. Vesical Imaging-Reporting and Data System (VI-RADS) scoring has proven to be a reliable tool for local staging of bladder cancer with high accuracy in preoperative staging, but VI-RADS still faces challenges and needs further improvement. Artificial intelligence (AI) holds great promise in improving the accuracy of diagnosis and predicting the prognosis of bladder cancer. Automated machine learning techniques based on radiomics features derived from MRI have been utilized in bladder cancer diagnosis and have demonstrated promising potential for practical implementation. Future work should focus on conducting more prospective, multicenter studies to validate the additional value of quantitative studies and optimize prediction models by combining other biomarkers, such as urine and serum biomarkers. This review assesses the value of multiparameter MRI in the accurate evaluation of muscular invasion of bladder cancer, as well as the current status and progress of its application in the evaluation of efficacy and prognosis.
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Affiliation(s)
- Kangwen He
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China (X.M.); (Z.L.)
| | - Xiaoyan Meng
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China (X.M.); (Z.L.)
| | - Yanchun Wang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China (X.M.); (Z.L.)
| | - Cui Feng
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China (X.M.); (Z.L.)
| | - Zheng Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China (X.M.); (Z.L.)
| | - Yonghua Niu
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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Necchi A, Basile G, Gibb EA, Raggi D, Calareso G, de Padua TC, Patanè D, Crupi E, Mercinelli C, Cigliola A, Tateo V, Giannatempo P, Moschini M, Briganti A, Montorsi F, Messina A, Ross JS, Pavlick D, De Cobelli F, Brembilla G. Vesical Imaging-Reporting and Data System use predicting the outcome of neoadjuvant pembrolizumab in muscle-invasive bladder cancer. BJU Int 2024; 133:214-222. [PMID: 37803523 DOI: 10.1111/bju.16191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
OBJECTIVE To evaluate the predictive capability of the pre- and post-pembrolizumab Vesical Imaging-Reporting and Data System (VI-RADS) to identify ypT0N0 or ypT≤1N0 response in muscle-invasive bladder cancer (MIBC) within the PURE-01 trial (ClinicalTrials.gov identifier: NCT02736266). PATIENTS AND METHODS Patients were staged with bladder multiparametric magnetic resonance imaging (mpMRI) before and after treatment (three cycles of pembrolizumab) prior to radical cystectomy (RC). Logistic regression models were used to analyse the pre- and post- pembrolizumab VI-RADS against ypT≤1N0 and ypT0N0 response. The VI-RADS scores were dichotomised between 0 and 3 (0 = no evidence of disease) and 4-5. Event-free survival (EFS) and overall survival (OS) analyses were performed. Comprehensive genomic profiling and transcriptome-wide expression profiling data were matched with the VI-RADS scores. RESULTS In total, 110 patients underwent centrally reviewed scans (N = 220 mpMRI), treated between February 2017 and July 2020. Both pre- and post-pembrolizumab VI-RADS 0-3 scores were the only significant covariates that predicted the ypT≤1N0 endpoint in multivariable analyses, and the strongest effect was seen with post-pembrolizumab VI-RADS 0-3 predicting the ypT≤1N0 response (P < 0.001). The area under the curve for this model was 0.90. Post-pembrolizumab VI-RADS 0-3 also predicted a longer EFS (P < 0.001) and OS (P = 0.044). The scores of several gene signatures from baseline tumours differed between the pre-pembrolizumab VI-RADS 0-3 and 4-5 categories. CONCLUSION Post-pembrolizumab VI-RADS scores are strongly associated with pathological downstaging and survival. VI-RADS scores were also characterised by distinct biomarker features. These results indicate that the VI-RADS is emerging as an important tool for designing next-generation trials for MIBC.
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Affiliation(s)
- Andrea Necchi
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Basile
- Department of Urology, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Daniele Raggi
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giuseppina Calareso
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Damiano Patanè
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Emanuele Crupi
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Chiara Mercinelli
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Antonio Cigliola
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Valentina Tateo
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Patrizia Giannatempo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Moschini
- Department of Urology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alberto Briganti
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Urology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Urology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Antonella Messina
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Jeffrey S Ross
- Foundation Medicine Inc, Cambridge, MA, USA
- SUNY Upstate Medical University, Syracuse, NY, USA
| | | | - Francesco De Cobelli
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Radiology, IRCCS Ospedale San Raffaele, Milan, Italy
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18
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Arita Y, Kwee TC, Woo S, Shigeta K, Ishii R, Okawara N, Edo H, Waseda Y, Vargas HA. Biparametric versus Multiparametric Magnetic Resonance Imaging for Assessing Muscle Invasion in Bladder Urothelial Carcinoma with Variant Histology Using the Vesical Imaging-Reporting and Data System. Eur Urol Focus 2024; 10:131-138. [PMID: 37633790 DOI: 10.1016/j.euf.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/27/2023] [Accepted: 08/11/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND The diagnostic performance of contrast medium-free biparametric magnetic resonance imaging (bpMRI; combining T2-weighted imaging [T2WI] and diffusion-weighted imaging [DWI]) for evaluating variant-histology urothelial carcinoma (VUC) remains unknown. OBJECTIVE To compare the diagnostic performance of bpMRI and multiparametric MRI (mpMRI; combining T2WI, DWI, and dynamic contrast-enhanced MRI]) for assessing muscle invasion of VUC. DESIGN, SETTING, AND PARTICIPANTS This multi-institution retrospective analysis included 118 patients with pathologically verified VUC who underwent bladder mpMRI before transurethral bladder tumor resection between 2010 and 2019. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Three board-certified radiologists separately evaluated two sets of images, set 1 (bpMRI) and set 2 (mpMRI), in accordance with the Vesical Imaging Reporting and Data System (VI-RADS). The histopathology results were utilized as a reference standard. Receiver operating characteristic curve analysis, Z test, and Wald test were used to assess diagnostic abilities. RESULTS AND LIMITATIONS Sixty-six (55.9%) and 52 (44.1%) of the 118 patients with VUC included in the analysis (mean age, 71 ± 10 yr; 88 men) had muscle-invasive bladder cancer (MIBC) and non-MIBC, respectively. For the diagnosis of MIBC, the areas under the curve for bpMRI were significantly smaller than those for mpMRI (0.870-0.884 vs 0.902-0.923, p < 0.05). The sensitivity of bpMRI was significantly lower than that of mpMRI for all readers with a VI-RADS cutoff score of 4 (65.2-66.7% vs 77.3-80.3%, p < 0.05). The specificity of bpMRI and mpMRI did not differ significantly for all readers (88.5-90.4 vs 88.5-92.3, p > 0.05). A limitation of the study is the limited sample size because of the rarity of VUC. CONCLUSIONS In patients with VUC, on applying VI-RADS, the diagnostic results of bpMRI were inferior to those of mpMRI for evaluating muscle invasion. Therefore, mpMRI-based methods are recommended for evaluating muscle invasiveness of VUC. PATIENT SUMMARY Contrast medium-free biparametric magnetic resonance imaging (bpMRI)-based Vesical Imaging Reporting and Data System (VI-RADS) can accurately diagnose pure urothelial carcinomas, similar to conventional multiparametric magnetic resonance imaging-based VI-RADS. However, bpMRI-based VI-RADS may misdiagnose muscle invasiveness of urothelial carcinoma with variant histology, particularly when its cutoff score is 4.
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Affiliation(s)
- Yuki Arita
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Radiology, Keio University School of Medicine, Tokyo, Japan.
| | - Thomas C Kwee
- Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
| | - Sungmin Woo
- Department of Radiology, NYU Langone Health, New York, NY, USA
| | - Keisuke Shigeta
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Ryota Ishii
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Naoko Okawara
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Hiromi Edo
- Department of Radiology, National Defence Medical College, Saitama, Japan
| | - Yuma Waseda
- Department of Urology, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
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Zhuang J, Cai L, Sun H, Wu Q, Li K, Yu R, Cao Q, Li P, Yang X, Lu Q. Vesical imaging reporting and data system (VI-RADS) could predict the survival of bladder-cancer patients who received radical cystectomy. Sci Rep 2023; 13:21502. [PMID: 38057353 PMCID: PMC10700510 DOI: 10.1038/s41598-023-48840-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 11/30/2023] [Indexed: 12/08/2023] Open
Abstract
Vesical Imaging Reporting and Data System (VI-RADS) shows good potential in determining muscle-invasive bladder cancer (MIBC) patients. However, whether VI-RADS could predict the prognosis of radical cystectomy (RC) patients has not been reported. Our purpose is to determine whether VI-RADS contributed to predict oncologic outcomes. In this retrospective study, we analysed the information of bladder cancer patients who admitted to our centre from June 2012 to June 2022. All patients who underwent multiparametric magnetic resonance imaging (mpMRI) and underwent RC were included. VI-RADS scoring was performed by two radiologists blinded to the clinical data. Patients' clinical features, pathology data, and imaging information were recorded. Kaplan-Meier method was used to estimate patients' overall survival (OS) and progression-free survival (PFS). Log-rank test was used to assess statistical differences. COX regression analysis was used to estimate risk factors. Ultimately, we included 219 patients, with 188 males and 31 females. The median age was 66 (IQR = 61-74.5) years. The VI-RADS scores were as follows: VI-RADS 1, 4 (1.8%); VI-RADS 2, 68 (31.1%); VI-RADS 3, 40 (18.3%); VI-RADS 4, 69 (31.5%); and VI-RADS 5, 38 (17.4%). Patients with VI-RADS ≥ 3 had poorer OS and PFS than those with VI-RADS < 3. The AUC of VI-RADS predicting 3-year OS was 0.804, with sensitivity of 0.824 and negative predictive value of 0.942. Multivariate COX analysis showed that VI-RADS ≥ 3 was risk factors for OS (HR = 3.517, P = 0.003) and PFS (HR = 4.175, P < 0.001). In the MIBC subgroup, patients with VI-RADS ≥ 4 had poorer OS and PFS. In the non-muscle invasive bladder cancer (NMIBC) subgroup, the prognosis of patients with VI-RADS ≥ 3 remained poorer. VI-RADS scores could effectively predict the survival of patients after RC.
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Affiliation(s)
- Juntao Zhuang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lingkai Cai
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Wuxi Medical Center, Nanjing Medical University, Wuxi, China
| | - Huanyou Sun
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qikai Wu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kai Li
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ruixi Yu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qiang Cao
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Pengchao Li
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiao Yang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
| | - Qiang Lu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Jazayeri SB, Dehghanbanadaki H, Hosseini M, Taghipour P, Bacchus MW, Di Valerio EA, Sarabchian E, Balaji K, Bandyk M. Can magnetic resonance imaging differentiate muscle invasion (T2) and lamina propria invasion (T1) urothelial carcinoma of the bladder? A systematic review and meta-analysis of Vesical Imaging-Reporting and Data System accuracy. Curr Urol 2023; 17:262-267. [PMID: 37994331 PMCID: PMC10662806 DOI: 10.1097/cu9.0000000000000214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 12/04/2022] [Indexed: 11/24/2023] Open
Abstract
Background Vesical Imaging-Reporting and Data System (VI-RADS) was developed as a structured reporting tool to anticipate the possibility of muscle invasion. This study is aimed to investigate the diagnostic accuracy of VI-RADS for discriminating T2 from T1 bladder cancer. Materials and methods Scopus, Web of Science, PubMed, and Embase were searched on October 4, 2021, for studies with the following characteristics: (1) bladder cancer patient population, (2) VI-RADS as an index test, (3) retransurethral resection of bladder tumor/cystectomy as a reference, and (4) adequate VI-RADS score data for T1 and T2 lesions. The analyses were performed using the binary regression model of MIDAS in Stata. Results Six studies with 624 magnetic resonance imaging reports were included. The receiver operating characteristics curve for differentiation of T2 from T1 bladder cancer showed an area under the curve of 0.93 (95% confidence interval [CI], 0.91-0.95) for a VI-RADS ≥3 and 0.75 (95% CI, 0.71-0.79) for a VI-RADS ≥4. A VI-RADS ≥3 showed high sensitivity of 93% (95% CI, 85%-97%), specificity of 61% (95% CI, 30%-86%), positive likelihood ratio of 2.4 (95% CI, 1.1-5.3), and negative likelihood ratio of 0.11 (95% CI, 0.05-0.24). A total of 10.4% of T2 lesions were scored as VI-RADS 2, while 10% of T1 lesions were scored as VI-RADS 4 or 5. Conclusions The VI-RADS ≥3 has high accuracy and sensitivity for detecting muscle invasion in borderline populations of T1 or T2 bladder cancer. Thus, the VI-RADS could be a good non-invasive screening test for the detection of T2 urothelial lesions.
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Affiliation(s)
- Seyed Behzad Jazayeri
- Department of Urology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Hojat Dehghanbanadaki
- Department of Urology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Mahdie Hosseini
- Department of Urology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Pourya Taghipour
- Department of Urology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Michael W. Bacchus
- Department of Urology, University of Florida College of Medicine, Gainesville, FL, USA
| | | | - Elnaz Sarabchian
- Department of Urology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - K.C. Balaji
- Department of Urology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Mark Bandyk
- Department of Urology, University of Florida College of Medicine, Jacksonville, FL, USA
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21
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Peng M, Chu X, Peng Y, Li D, Zhang Z, Wang W, Zhou X, Xiao D, Yang X. Targeted therapies in bladder cancer: signaling pathways, applications, and challenges. MedComm (Beijing) 2023; 4:e455. [PMID: 38107059 PMCID: PMC10724512 DOI: 10.1002/mco2.455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/19/2023] Open
Abstract
Bladder cancer (BC) is one of the most prevalent malignancies in men. Understanding molecular characteristics via studying signaling pathways has made tremendous breakthroughs in BC therapies. Thus, targeted therapies including immune checkpoint inhibitors (ICIs), antibody-drug conjugates (ADCs), and tyrosine kinase inhibitor (TKI) have markedly improved advanced BC outcomes over the last few years. However, the considerable patients still progress after a period of treatment with current therapeutic regimens. Therefore, it is crucial to guide future drug development to improve BC survival, based on the molecular characteristics of BC and clinical outcomes of existing drugs. In this perspective, we summarize the applications and benefits of these targeted drugs and highlight our understanding of mechanisms of low response rates and immune escape of ICIs, ADCs toxicity, and TKI resistance. We also discuss potential solutions to these problems. In addition, we underscore the future drug development of targeting metabolic reprogramming and cancer stem cells (CSCs) with a deep understanding of their signaling pathways features. We expect that finding biomarkers, developing novo drugs and designing clinical trials with precisely selected patients and rationalized drugs will dramatically improve the quality of life and survival of patients with advanced BC.
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Affiliation(s)
- Mei Peng
- Department of PharmacyXiangya HospitalCentral South UniversityChangshaHunanChina
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan ProvinceThe Research Center of Reproduction and Translational Medicine of Hunan ProvinceKey Laboratory of Chemical Biology & Traditional Chinese Medicine Research of Ministry of EducationDepartment of PharmacySchool of MedicineHunan Normal UniversityChangshaHunanChina
| | - Xuetong Chu
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan ProvinceThe Research Center of Reproduction and Translational Medicine of Hunan ProvinceKey Laboratory of Chemical Biology & Traditional Chinese Medicine Research of Ministry of EducationDepartment of PharmacySchool of MedicineHunan Normal UniversityChangshaHunanChina
| | - Yan Peng
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan ProvinceThe Research Center of Reproduction and Translational Medicine of Hunan ProvinceKey Laboratory of Chemical Biology & Traditional Chinese Medicine Research of Ministry of EducationDepartment of PharmacySchool of MedicineHunan Normal UniversityChangshaHunanChina
| | - Duo Li
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan ProvinceThe Research Center of Reproduction and Translational Medicine of Hunan ProvinceKey Laboratory of Chemical Biology & Traditional Chinese Medicine Research of Ministry of EducationDepartment of PharmacySchool of MedicineHunan Normal UniversityChangshaHunanChina
| | - Zhirong Zhang
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan ProvinceThe Research Center of Reproduction and Translational Medicine of Hunan ProvinceKey Laboratory of Chemical Biology & Traditional Chinese Medicine Research of Ministry of EducationDepartment of PharmacySchool of MedicineHunan Normal UniversityChangshaHunanChina
| | - Weifan Wang
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan ProvinceThe Research Center of Reproduction and Translational Medicine of Hunan ProvinceKey Laboratory of Chemical Biology & Traditional Chinese Medicine Research of Ministry of EducationDepartment of PharmacySchool of MedicineHunan Normal UniversityChangshaHunanChina
| | - Xiaochen Zhou
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan ProvinceThe Research Center of Reproduction and Translational Medicine of Hunan ProvinceKey Laboratory of Chemical Biology & Traditional Chinese Medicine Research of Ministry of EducationDepartment of PharmacySchool of MedicineHunan Normal UniversityChangshaHunanChina
| | - Di Xiao
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan ProvinceThe Research Center of Reproduction and Translational Medicine of Hunan ProvinceKey Laboratory of Chemical Biology & Traditional Chinese Medicine Research of Ministry of EducationDepartment of PharmacySchool of MedicineHunan Normal UniversityChangshaHunanChina
| | - Xiaoping Yang
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan ProvinceThe Research Center of Reproduction and Translational Medicine of Hunan ProvinceKey Laboratory of Chemical Biology & Traditional Chinese Medicine Research of Ministry of EducationDepartment of PharmacySchool of MedicineHunan Normal UniversityChangshaHunanChina
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22
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Chen G, Fan X, Wang T, Zhang E, Shao J, Chen S, Zhang D, Zhang J, Guo T, Yuan Z, Tang H, Yu Y, Chen J, Wang X. A machine learning model based on MRI for the preoperative prediction of bladder cancer invasion depth. Eur Radiol 2023; 33:8821-8832. [PMID: 37470826 DOI: 10.1007/s00330-023-09960-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 04/27/2023] [Accepted: 05/24/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVES To construct and validate a prediction model based on full-sequence MRI for preoperatively evaluating the invasion depth of bladder cancer. METHODS A total of 445 patients with bladder cancer were divided into a seven-to-three training set and test set for each group. The radiomic features of lesions were extracted automatically from the preoperative MRI images. Two feature selection methods were performed and compared, the key of which are the Least Absolute Shrinkage and Selection Operator (LASSO) and the Max Relevance Min Redundancy (mRMR). The classifier of the prediction model was selected from six advanced machine-learning techniques. The receiver operating characteristic (ROC) curves and the area under the curve (AUC) were applied to assess the efficiency of the models. RESULTS The models with the best performance for pathological invasion prediction and muscular invasion prediction consisted of LASSO as the feature selection method and random forest as the classifier. In the training set, the AUC of the pathological invasion model and muscular invasion model were 0.808 and 0.828. Furthermore, with the mRMR as the feature selection method, the external invasion model based on random forest achieved excellent discrimination (AUC, 0.857). CONCLUSIONS The full-sequence models demonstrated excellent accuracy for preoperatively predicting the bladder cancer invasion status. CLINICAL RELEVANCE STATEMENT This study introduces a full-sequence MRI model for preoperative prediction of the depth of bladder cancer infiltration, which could help clinicians to recognise pathological features associated with tumour infiltration prior to invasive procedures. KEY POINTS • Full-sequence MRI prediction model performed better than Vesicle Imaging-Reporting and Data System (VI-RADS) for preoperatively evaluating the invasion status of bladder cancer. • Machine learning methods can extract information from T1-weighted image (T1WI) sequences and benefit bladder cancer invasion prediction.
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Affiliation(s)
- Guihua Chen
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Xuhui Fan
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tao Wang
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Encheng Zhang
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Jialiang Shao
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Siteng Chen
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200135, China
| | - Dongliang Zhang
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Jian Zhang
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Tuanjie Guo
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Zhihao Yuan
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Heting Tang
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Yaoyu Yu
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Jinyuan Chen
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Xiang Wang
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China.
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Ahn H, Kim TM, Hwang SI, Lee HJ, Choe G, Hong SK, Byun SS, Oh JJ. Tumor contact length with bladder wall provides effective risk stratification for lesions with a VIRADS score of 2-3. Eur Radiol 2023; 33:8417-8425. [PMID: 37438641 DOI: 10.1007/s00330-023-09925-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/17/2023] [Accepted: 05/14/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVES To evaluate the diagnostic performance of the tumor contact length (TCL) in the prediction of MIBC (muscle-invasive bladder cancer) in lesions corresponding to the vesical imaging-reporting and data system (VIRADS) score 2-3. METHODS This is a single institution, retrospective study targeting 191 consecutive patients assigned of VIRADS score 2-3, who had pre-transurethral resection MRI from July 2019 to September 2021. Logistic regression analyses were performed to determine meaningful predictors of MIBC for this score group, and a nomogram was plotted with those variables. The diagnostic performance of each predictor was compared at predefined thresholds (VIRADS score 3 and TCL 3 cm) using the generalized linear model and ROC analysis. RESULTS Both VIRADS score and TCL remained independent predictors of MIBC for this score group (odds ratio 7.3 for VIRADS score, and 1.3 for TCL, p < 0.01 for both). The contribution of TCL to the probability of MIBC in the nomogram was greater than that of the VIRADS score. VIRADS score had a sensitivity of 0.54 (14/26), specificity of 0.92 (203/221), and diagnostic accuracy of 0.88 (217/247), and TCL showed a sensitivity of 0.89 (23/26), specificity of 0.95 (209/221), and diagnostic accuracy of 0.94 (232/247). The difference in sensitivity (p = 0.03) and accuracy (p = 0.04) was statistically significant. The AUC was also significantly wider for TCL than for VIRADS (0.97 vs. 0.73, p < 0.01). CONCLUSION A simple index, TCL, may be helpful in further risk stratification for MIBC in patients with a score of VIRADS 2-3. CLINICAL RELEVANCE STATEMENT For bladder cancer patients with insufficient qualitative evidence of muscle layer invasion using VIRADS categorization, TCL, a simple quantitative indicator defined as the curvilinear contact length between the bladder wall and the tumor, may be helpful in risk stratification. KEY POINTS • Even when only lesions with score 2-3 were targeted, VIRADS was still a meaningful indicator of MIBC. • With a predefined threshold of 3 cm applied, TCL outperformed VIRADS in the score 2-3 group, in predicting MIBC. • A longer TCL for a lesion with a VIRADS score 2 may warrant an additional warning for MIBC, whereas a shorter TCL for a lesion with a score 3 may indicate a lower risk of MIBC.
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Affiliation(s)
- Hyungwoo Ahn
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Taek Min Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Sung Il Hwang
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hak Jong Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Gheeyoung Choe
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung Kyu Hong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong Jin Oh
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
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24
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Li HZ, Zhu J, Weng GJ, Li JJ, Li L, Zhao JW. Application of nanotechnology in bladder cancer diagnosis and therapeutic drug delivery. J Mater Chem B 2023; 11:8368-8386. [PMID: 37580958 DOI: 10.1039/d3tb01323e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
Bladder cancer (BC) is one of the most common malignant tumors in the urinary system, and its high recurrence rate is a great economic burden to patients. Traditional diagnosis and treatment methods have the disadvantages of insufficient targeting, obvious side effects and low sensitivity, which seriously limit the accurate diagnosis and efficient treatment of BC. Due to their small size, easy surface modification, optical properties such as plasmon resonance, and surface enhanced Raman scattering, good electrical conductivity and photothermal conversion properties, nanomaterials have great potential application value in the realization of specific diagnosis and targeted therapy of BC. At present, the application of nanomaterials in the diagnosis and treatment of BC is attracting great attention and achieving rich research results. Therefore, this paper summarizes the recent research on nanomaterials in the diagnosis and treatment of BC, clarifies the existing advantages and disadvantages, and provides theoretical guidance for promoting the accurate diagnosis and efficient treatment of BC.
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Affiliation(s)
- Hang-Zhuo Li
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China.
| | - Jian Zhu
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China.
| | - Guo-Jun Weng
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China.
| | - Jian-Jun Li
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China.
| | - Lei Li
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
| | - Jun-Wu Zhao
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, 710049, China.
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25
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Kimura K, Yoshida S, Tsuchiya J, Kitazume Y, Waseda Y, Tanaka H, Yokoyama M, Toda K, Yoshimura R, Masaya I, Koga F, Tateishi U, Fujii Y. Novel utility of Vesical Imaging-Reporting and Data System in multimodal treatment for muscle-invasive bladder cancer. Eur Radiol 2023; 33:6245-6255. [PMID: 37045982 DOI: 10.1007/s00330-023-09627-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/05/2023] [Accepted: 02/26/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVES To examine the clinical significance of the Vesical Imaging-Reporting and Data System (VI-RADS) in predicting outcome of multimodal treatment (MMT) in muscle-invasive bladder cancer (MIBC) patients. METHODS We reviewed 78 pathologically proven MIBC patients who underwent MMT including transurethral resection and chemoradiotherapy, followed by partial or radical cystectomy. Treatment response was assessed through histologic evaluation of cystectomy specimens. Two radiologists categorized the index lesions of pretherapeutic MRI according to the 5-point VI-RADS score. The associations of VI-RADS score with the therapeutic effect of MMT were analyzed. The diagnostic performance of VI-RADS scores with a cut-off VI-RADS scores ≤ 2 or ≤ 3 for predicting pathologic complete response to MMT (MMT-CR) was evaluated. RESULTS MMT-CR was achieved in 2 (100%) of VI-RADS score 1 (n = 2), 16 (84%) of score 2 (n = 19), 12 (86%) of score 3 (n = 14), 7 (64%) of score 4 (n = 11), and 14 (44%) of score 5 (n = 32). VI-RADS score was inversely associated with the incidence of MMT-CR (p = 0.00049). The cut-off VI-RADS score ≤ 2 and ≤ 3 could predict the favorable therapeutic outcome of MMT with high specificity (0.89 with 95% confidence interval [CI]: 0.71-0.98 and 0.82 with 95% CI: 0.62-0.94, respectively) and high positive predictive value (0.86 with 95% CI: 0.64-0.97 and 0.86 with 95% CI: 0.70-0.95, respectively). CONCLUSION VI-RADS score may serve as an imaging marker in MIBC patients for predicting the therapeutic outcome of MMT. CLINICAL RELEVANCE STATEMENT Muscle-invasive bladder cancer patients with a lower Vesical Imaging-Reporting and Data System score can be a good candidate for bladder-sparing treatment incorporating multimodal treatment. KEY POINTS • Vesical Imaging-Reporting and Data System (VI-RADS) score was potentially valuable for classifying pathologic tumor response in patients with muscle-invasive bladder cancer. • The likelihood of achieving complete response of multimodal treatment (MMT) decreased with increasing VI-RADS score. • VI-RADS score could serve as an imaging marker that optimizes patient selection for MMT.
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Affiliation(s)
- Koichiro Kimura
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan.
| | - Junichi Tsuchiya
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Yoshio Kitazume
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Yuma Waseda
- Department of Urology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Hajime Tanaka
- Department of Urology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Minato Yokoyama
- Department of Urology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Kazuma Toda
- Department of Radiation Therapeutics and Oncology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Ryoichi Yoshimura
- Department of Radiation Therapeutics and Oncology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Ito Masaya
- Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Fumitaka Koga
- Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Ukihide Tateishi
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
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Yilmaz EC, Belue MJ, Turkbey B, Reinhold C, Choyke PL. A Brief Review of Artificial Intelligence in Genitourinary Oncological Imaging. Can Assoc Radiol J 2023; 74:534-547. [PMID: 36515576 DOI: 10.1177/08465371221135782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Genitourinary (GU) system is among the most commonly involved malignancy sites in the human body. Imaging plays a crucial role not only in diagnosis of cancer but also in disease management and its prognosis. However, interpretation of conventional imaging methods such as CT or MR imaging (MRI) usually demonstrates variability across different readers and institutions. Artificial intelligence (AI) has emerged as a promising technology that could improve the patient care by providing helpful input to human readers through lesion detection algorithms and lesion classification systems. Moreover, the robustness of these models may be valuable in automating time-consuming tasks such as organ and lesion segmentations. Herein, we review the current state of imaging and existing challenges in GU malignancies, particularly for cancers of prostate, kidney and bladder; and briefly summarize the recent AI-based solutions to these challenges.
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Affiliation(s)
- Enis C Yilmaz
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Mason J Belue
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Caroline Reinhold
- McGill University Health Center, McGill University, Montreal, Canada
| | - Peter L Choyke
- Molecular Imaging Branch, National Cancer Institute, NIH, Bethesda, MD, USA
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27
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Jiang W, Pan C, Guo W, Xu Z, Ni Q, Ruan Y. Pathologic collision of urinary bladder urothelial carcinoma with small cell carcinoma: a case report. Diagn Pathol 2023; 18:80. [PMID: 37434193 DOI: 10.1186/s13000-023-01369-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/27/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Urothelial carcinoma is a major subtype of bladder cancer and small cell carcinoma (SCC) is a rare type of cancer in clinical practice. Pathologic collision of urinary bladder urothelial carcinoma with SCC is not common in clinical settings. CASE PRESENTATION Here, we report a patient with high-grade papillary carcinoma which changed to collision tumor with SCC. The patient underwent radical cystectomy; however, neck and mediastinum lymph nodes metastases were detected 11 months after the operation. The lymph nodes were diagnosed pathologically as SCC. Chemoradiotherapy was subsequently prescribed. Unfortunately, this patient died of COVID-19 in early 2023. DISCUSSION We hypothesized the mechanism underlying this pathological transformation. For patients with urothelial bladder cancer, pathological analysis should be conducted to allow standardized and persistent treatment. Moreover, drugs should be selected depending on the type of pathology, especially for patients who develop relapse, since collision tumor or other pathological tumors may be present. CONCLUSIONS We recommend that radical cystectomy be performed early enough for patients with non-muscle invasive bladder cancer, who are at a high risk of tumor recurrence. However, this conclusion needs to be validated in a larger number of patients.
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Affiliation(s)
- Wei Jiang
- Department of Urological Surgery, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, Taizhou, 225300, Jiangsu, P.R. China
| | - Chi Pan
- Department of General Surgery, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, Taizhou, 225300, Jiangsu, P.R. China
| | - Wei Guo
- Department of Urological Surgery, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, Taizhou, 225300, Jiangsu, P.R. China
| | - Zhen Xu
- Department of Urological Surgery, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, Taizhou, 225300, Jiangsu, P.R. China
| | - Qingtao Ni
- Department of Oncology, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, Taizhou, 225300, Jiangsu, P.R. China.
| | - Yashi Ruan
- Department of Urological Surgery, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, Taizhou, 225300, Jiangsu, P.R. China.
- Department of Oncology, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou School of Clinical Medicine, Nanjing Medical University, Taizhou, 225300, Jiangsu, P.R. China.
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28
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Alam SM, Martin A, McLeay MT, Smith H, Golshani M, Thompson J, Sardiu M, Best S, Taylor JA. Predictive Value of Computed Tomography Following Neoadjuvant Chemotherapy for Muscle Invasive Bladder Cancer. Bladder Cancer 2023; 9:167-174. [PMID: 38993298 PMCID: PMC11181745 DOI: 10.3233/blc-230015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/12/2023] [Indexed: 07/13/2024]
Abstract
BACKGROUND Neoadjuvant chemotherapy (NAC) prior to radical cystectomy (RC) remains standard treatment for select patients with muscle-invasive bladder cancer (MIBC). Although computed tomography (CT) is often obtained prior to RC, its ability to predict pathologic response is poorly characterized. OBJECTIVE The purpose of this study is to evaluate the predictive value of CT in assessing disease burden after NAC. METHODS Patients with MIBC having received NAC prior to RC were identified. Pre- and post-NAC CT scans were reviewed by an abdominal radiologist. The correlation between pathologic complete response (PCR) and radiologic complete response (RCR) was determined as the primary aim. As a secondary aim, the correlation between pathologic partial response (PPR) and radiologic partial response (RPR) was determined. Logistic regression analysis was utilized to determine the predictive value of CT in determining disease burden at RC. RESULTS A total of 141 patients were identified for analysis. PCR and PPR was achieved in 34% and 16% of patients, respectively. The positive predictive value of post-NAC CT was 53.5% for PCR and 28.8% for PPR. The negative predictive value of post-NAC CT was 73.5% for PCR and 46.2% for PPR. There was no significant association between RCR and PCR (OR 1.13, p = 0.67). Similarly, there was no meaningful association between RPR and PPR, lymph node involvement, or presence of extravesical disease. CONCLUSIONS CT findings correlate poorly with final pathology at RC and should not be used to evaluate local disease burden.
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Affiliation(s)
- Syed M Alam
- Department of Urology, University of Kansas Health System, Kansas City, KS, USA
| | - Austin Martin
- Department of Urology, University of Kansas Health System, Kansas City, KS, USA
| | - Matthew T McLeay
- Department of Urology, University of Kansas Health System, Kansas City, KS, USA
| | - Holly Smith
- Department of Biostatistics and Data Science, University of Kansas, Kansas City, KS, USA
| | - Mahgol Golshani
- Department of Urology, University of Kansas Health System, Kansas City, KS, USA
| | - Jeffrey Thompson
- Department of Biostatistics and Data Science, University of Kansas, Kansas City, KS, USA
| | - Mihaela Sardiu
- Department of Biostatistics and Data Science, University of Kansas, Kansas City, KS, USA
| | - Shaun Best
- Department of Radiology, University of Kansas Health System, Kansas City, KS, USA
| | - John A Taylor
- Department of Urology, University of Kansas Health System, Kansas City, KS, USA
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29
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Teoh JYC, Cho CL, Chan RCK, Liu K, Zhao H, Giannarini G, Enikeev D, Ng CF, Teoh AYB. A proof-of-concept study on endoscopic ultrasound-guided biopsy of detrusor muscle in porcine bladders. Front Oncol 2023; 13:1160463. [PMID: 37333813 PMCID: PMC10272740 DOI: 10.3389/fonc.2023.1160463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/23/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Conventionally, we rely on transurethral resection of bladder tumour (TURBT) for local staging of muscle-invasive bladder cancer (MIBC). However, the procedure is limited by its staging inaccuracy which may delay the definitive treatment of MIBC. Methods We conducted a proof-of concept study on endoscopic ultrasound (EUS)-guided biopsy of detrusor muscle in porcine bladders. Five porcine bladders were used in this experiment. Upon EUS, four layers of tissue including the mucosa (hypoechoic), submucosa (hyperechoic), detrusor muscle (hypoechoic) and serosa (hyperechoic) could be identified. Results A total of 37 EUS-guided biopsies were taken from 15 sites (three sites per bladder), and the mean number of biopsies taken from each site was 2.47±0.64. Among the 37 biopsies, 30 of them (81.1%) obtained detrusor muscle in the biopsy specimen. For the per biopsy site analysis, detrusor muscle was obtained in 73.3% if only one biopsy was taken, and 100% if two or more biopsies were taken from the same biopsy site. Overall, detrusor muscle was successfully obtained from all 15 biopsy sites (100%). No bladder perforation was observed throughout all biopsy processes. Conclusion EUS-guided biopsy of the detrusor muscle could be performed during the initial cystoscopy session, thus expediting the histological diagnosis and subsequent treatment of MIBC.
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Affiliation(s)
- Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Urothelial Carcinoma Working Group, European Association of Urology – Young Academic Urologists (EAU-YAU), Arnhem, Netherlands
| | - Chak-Lam Cho
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Ronald Cheong-Kin Chan
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Kang Liu
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Hongda Zhao
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Gianluca Giannarini
- Urology Unit, “Santa Maria della Misericordia” University Hospital, Udine, Italy
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Chi-Fai Ng
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Anthony Yuen-Bun Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Rysankova K, Hanzlikova P, Zidlik V, Vrtkova A, Slisarenko M, Skarda J, Grepl M, Krhut J. Is high accuracy of Vesical Imaging-Reporting and Data System (VI-RADS) sufficient for its implementation in the urological practice? Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2023; 167:85-90. [PMID: 36628563 DOI: 10.5507/bp.2022.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/14/2022] [Indexed: 01/12/2023] Open
Abstract
AIMS Currently, the only method used to differentiate between MIBC and NMIBC is transurethral resection of the bladder tumour (TURBT). Magnetic resonance and Vesical Imaging-Reporting and Data System (VI-RADS) would allow for discrimination between NMIBC and MIBC. We evaluate the sensitivity and specificity of VI-RADS in the diagnosis of muscle-invasive bladder cancer and discuss its value in everyday urological practice. METHODS 64 patients with bladder cancer (BC) were enrolled into this prospective study. Multiparametric magnetic resonance imaging (mpMRI) was performed before transurethral resection of the bladder tumour (TURBT) and evaluated using the VI-RADS score. Score were compared to histopathology results. We evaluated the sensitivity, specificity, positive and negative predictive value of this system using both cut-off VI-RADS ≥ 3 and ≥ 4. RESULTS Sensitivity of 92.3% (95%CI: 64.0; 99.8), specificity of 81.4% (95%CI: 69.1; 90.3), positive predictive value of 52.2% (95%CI: 30.6; 73.2) and negative predictive value of 98.0% (95%CI: 89.1; 99.9) was determined using cut off VI-RADS ≥ 3, while sensitivity of 76.9% (95%CI: 46.2; 95.0), specificity of 91.5% (95%CI: 81.3; 97.2), positive predictive value of 66.7% (95%CI: 38.4; 88.2), and negative predictive value of 94.7% (95%CI: 85.4; 98.9) was determined using cut-off VI-RADS ≥ 4. Based on our results, we consider the optimal cut-off point to be VI-RADS ≥ 3 with the overall prediction accuracy of 83.3% (95%CI: 72.7; 91.1). CONCLUSIONS We acknowledge that mpMRI provides valuable information with regard to BC staging, however, despite its high overall accuracy, we do not consider the VI-RADS could replace TURBT in discrimination between non-muscle invasive and MIBC.
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Affiliation(s)
- Katerina Rysankova
- Department of Urology, University Hospital Ostrava, Czech Republic.,Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Czech Republic
| | - Pavla Hanzlikova
- Department of Radiology, University Hospital Ostrava, Czech Republic.,Department of Imaging Methods, Faculty of Medicine, University of Ostrava, Czech Republic
| | - Vladimir Zidlik
- Department of Pathology, University Hospital Ostrava, Czech Republic.,Department of Molecular and Clinical Pathology and Medical Genetics, Faculty of Medicine, University of Ostrava, Czech Republic
| | - Adela Vrtkova
- Department of Applied Mathematics, Faculty of Electrical Engineering and Computer Science, VSB - Technical University Ostrava, Czech Republic.,Department of Deputy Director for Science and Research, University Hospital Ostrava, Czech Republic
| | - Maryna Slisarenko
- Department of Pathology, Faculty of Medicine in Pilzen, Charles University, Pilzen, Czech Republic
| | - Jozef Skarda
- Department of Pathology, University Hospital Ostrava, Czech Republic.,Department of Molecular and Clinical Pathology and Medical Genetics, Faculty of Medicine, University of Ostrava, Czech Republic
| | - Michal Grepl
- Department of Urology, University Hospital Ostrava, Czech Republic.,Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Czech Republic
| | - Jan Krhut
- Department of Urology, University Hospital Ostrava, Czech Republic.,Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Czech Republic
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Gupta P, Sarangi SS, Singh M, Pandey H, Choudhary GR, Madduri VKS, Bhirud DP, Sandhu AS, Jena R. To determine correlation between VIRADS scoring and pathological staging in bladder cancer: A prospective study and review of literature. Urologia 2023:3915603231151738. [PMID: 36847430 DOI: 10.1177/03915603231151738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
The development of standardized reporting systems is of paramount importance in medical-imaging. Based on the "RADS" methodology, PIRADS and BI-RADS have been successfully used. The management of bladder cancer (BC) depends on the stage at the time of identification. Accurate assessment of the muscle-invasive stage can alter therapies that are radically different. MRI can accurately diagnose this in a standardized manner (Vesical Imaging-Reporting and Data System: VIRADS) and spare additional procedures. The aim of the study is to determine diagnostic accuracy of VIRADS scoring in evaluation of muscle invasiveness in patients with BC. This study was conducted in a single center over a period of 2 years from April 2020. A total of 76 patients with bladder SOL/diagnosed BC were included. Final VIRADS scoring was calculated and compared with histopathological report.76 patients were evaluated which included 64 males and 12 females. Most of the cases came under the VIRADS-II category (23, 30.26%) followed by VIRADS-V (17, 22.36%). VIRADS-I was reported in 14 cases (18.42%). A total of 8 cases (10.52 %) were reported as VIRADS III and 14 cases (18.42%) as VIRADS IV. VIRADS-III was taken as cut off and found to have a sensitivity of 94.44%, a specificity of 87.50%, a positive predictive value of 87.17% and a negative predictive value of 94.59%. Though number of cases are still less to accurately predict test characteristics of VIRADS, our results are consistent with previously done retrospective studies and VIRADS has got good correlation with pathological staging.
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Affiliation(s)
- Prateek Gupta
- Department of Urology, Aadhar Health Institute, Hisar, Haryana, India
| | - Shakti Swarup Sarangi
- Department of Urology All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Mahendra Singh
- Department of Urology All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Himanshu Pandey
- Department of Urooncology, MPMMC-TMH, Varanasi, Uttar Pradesh, India
| | - Gautam Ram Choudhary
- Department of Urology All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | | | - Deepak Prakash Bhirud
- Department of Urology All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Arjun Singh Sandhu
- Department of Urology All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Rahul Jena
- Department of Urology All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Identification and validation of RB1 as an immune-related prognostic signature based on tumor mutation burdens in bladder cancer. Anticancer Drugs 2023; 34:269-280. [PMID: 36206128 PMCID: PMC9815815 DOI: 10.1097/cad.0000000000001399] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Bladder cancer (BCa) is one of the most common malignant tumors in the urinary system. Developing effective prognostic gene and exploring the immune cells that affect the prognosis of tumor are required. Full transcriptome data ( n = 433), clinical information ( n = 581) and mutation sequencing ( n = 412) were obtained from The Cancer Genome Atlas and independent mutation sequencing data of 101 samples were acquired from International Cancer Genome Consortium. Statistical processing was conducted using R packages. Gene biologically functional research was performed with gene set enrichment analysis based on Kyoto Encyclopedia of Genes and Genomes database. Twenty-two types of immune cell infiltration were assessed and calculated in 398 samples of BCa. Furthermore, the expression of immune-related prognostic signature was verified. The relationship between prognostic gene and immune cells was explored preliminarily. Tumor mutation burdens of mutant-type groups were higher than wild-type groups of 19 genes, except for FGFR3 and CREBBP. Kaplan-Meier analysis showed that high frequency of retinoblastomal 1 (RB1) mutation led to poor prognosis of BCa patients and was an independent prognostic factor ( P = 0.004; HR = 1.776). Proportions and correlation of 22 types of immune cells in 433 samples were determined. We found that RB1 expression decreased in BCa validated through quantitative PCR and immunohistochemistry. In addition, regulatory T cells (Tregs) were detected as a negatively correlated type of immune cell to mutation of RB1, whereas fluorescence costaining showed that Foxp3 expression of Tregs infiltration was negatively related to the expression of RB1. Mutation of RB1 can be identified as an independent prognostic predictor of BCa, and it may suppress the infiltration of Tregs in BCa tissues, increasing the incidence of tumor immune escape.
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Leonardo C, Flammia RS, Lucciola S, Proietti F, Pecoraro M, Bucca B, Licari LC, Borrelli A, Bologna E, Landini N, Del Monte M, Chung BI, Catalano C, Magliocca FM, De Berardinis E, Del Giudice F, Panebianco V. Performance of Node-RADS Scoring System for a Standardized Assessment of Regional Lymph Nodes in Bladder Cancer Patients. Cancers (Basel) 2023; 15:cancers15030580. [PMID: 36765540 PMCID: PMC9913205 DOI: 10.3390/cancers15030580] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/15/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Current cross-sectional imaging modalities exhibit heterogenous diagnostic performances for the detection of a lymph node invasion (LNI) in bladder cancer (BCa) patients. Recently, the Node-RADS score was introduced to provide a standardized comprehensive evaluation of LNI, based on a five-item Likert scale accounting for both size and configuration criteria. In the current study, we hypothesized that the Node-RADS score accurately predicts the LNI and tested its diagnostic performance. METHODS We retrospectively reviewed BCa patients treated with radical cystectomy (RC) and bilateral extended pelvic lymph node dissection, from January 2019 to June 2022. Patients receiving preoperative systemic chemotherapy were excluded. A logistic regression analysis tested the correlation between the Node-RADS score and LNI both at patient and lymph-node level. The ROC curves and the AUC depicted the overall diagnostic performance. In addition, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for different cut-off values (>1, >2, >3, >4). RESULTS Overall, data from 49 patients were collected. Node-RADS assigned on CT scans images, was found to independently predict the LNI after an adjusted multivariable regression analysis, both at the patient (OR 3.36, 95%CI 1.68-9.40, p = 0.004) and lymph node (OR 5.18, 95%CI 3.39-8.64, p < 0.001) levels. Node-RADS exhibited an AUC of 0.87 and 0.91 at the patient and lymph node levels, respectively. With increasing Node-RADS cut-off values, the specificity and PPV increased from 57.1 to 97.1% and from 48.3 to 83.3%, respectively. Conversely, the sensitivity and NPV decreased from 100 to 35.7% and from 100 to 79.1%, respectively. Similar trends were recorded at the lymph node level. Potentially, Node-RADS > 2 could be considered as the best cut-off value due to balanced values at both the patient (77.1 and 78.6%, respectively) and lymph node levels (82.4 and 93.4%, respectively). CONCLUSIONS The current study lays the foundation for the introduction of Node-RADS for the regional lymph-node evaluation in BCa patients. Interestingly, the Node-RADS score exhibited a moderate-to-high overall accuracy for the identification of LNI, with the possibility of setting different cut-off values according to specific clinical scenarios. However, these results need to be validated on larger cohorts before drawing definitive conclusions.
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Affiliation(s)
- Costantino Leonardo
- Department of Maternal Infant and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy
| | - Rocco Simone Flammia
- Department of Maternal Infant and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy
| | - Sara Lucciola
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University, 00161 Rome, Italy
| | - Flavia Proietti
- Department of Maternal Infant and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy
| | - Martina Pecoraro
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University, 00161 Rome, Italy
| | - Bruno Bucca
- Department of Maternal Infant and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy
| | - Leslie Claire Licari
- Department of Maternal Infant and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy
| | - Antonella Borrelli
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University, 00161 Rome, Italy
| | - Eugenio Bologna
- Department of Maternal Infant and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy
| | - Nicholas Landini
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University, 00161 Rome, Italy
| | - Maurizio Del Monte
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University, 00161 Rome, Italy
| | - Benjamin I. Chung
- Department of Urology, Standford University School of Medicine, Standford, CA 94305, USA
| | - Carlo Catalano
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University, 00161 Rome, Italy
| | - Fabio Massimo Magliocca
- Department of Anatomopathological, Oncology and Pathology, Sapienza University, 00161 Rome, Italy
| | - Ettore De Berardinis
- Department of Maternal Infant and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy
| | - Francesco Del Giudice
- Department of Maternal Infant and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy
- Department of Urology, Standford University School of Medicine, Standford, CA 94305, USA
- Correspondence: or ; Tel.: +39-0649975463; Fax: +39-0649978509
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University, 00161 Rome, Italy
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Liu Y, Xu X, Wang H, Liu Y, Wang Y, Dong Q, Li Z, Guo Y, Lu H. The Additional Value of Tri-parametric MRI in Identifying Muscle-invasive Status in Bladder Cancer. Acad Radiol 2023; 30:64-76. [PMID: 35676179 DOI: 10.1016/j.acra.2022.04.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/06/2022] [Accepted: 04/15/2022] [Indexed: 12/24/2022]
Abstract
RATIONALE AND OBJECTIVES Identification of muscle-invasive status (MIS) of bladder cancer (BCa) is critical for treatment decisions. The Vesical Imaging-Reporting and Data System (VI-RADS) has been widely used in preoperatively predicting MIS using tri-parametric MR imaging including T2-weighted (T2W), diffusion-weighted (DW), and dynamic contrast-enhanced (DCE) sequences. While the diagnostic values of radiomics features from bi-parametric MRI such as T2W + DW to identification of MIS have been reported, whether the tri-parametric MRI could provide additional diagnostic value to the radiomics prediction task, and how to integrate DCE features into the radiomics model, which is the objectives of this study, remain unknown. MATERIALS AND METHODS Patients with postoperatively confirmed BCa lesions (150 in non-muscle-invasive BCa and 56 in muscle-invasive BCa groups) were retrospectively included. Their T2W, DW with apparent diffusion coefficient (ADC) maps, and DCE sequences were acquired using a 3.0T MR system. Regions of interest were manually depicted and VI-RADS scores were assessed by three radiologists. Three predictive models were developed by the radiomics features extracted from sequence combinations of T2W + DW (Model one), T2W + DCE (Model two), and T2W + DW + DCE (Model three), respectively, using the least absolute shrinkage and selection operator. The performance of each model was quantitatively assessed on both the training (n = 165) and testing (n = 41) cohorts. Then a 10 times five-fold cross validation was conducted to assess the overall performance. RESULTS Three models achieved area under the curve of 0.888, 0.869, and 0.901 in the cross validation, respectively. The tri-parametric model performed significantly superior than the two bi-parametric models and VI-RADS. The analysis of feature coefficients derived from least absolute shrinkage and selection operator algorithm showed features from the tri-parametric MRI are effective in MIS discrimination. CONCLUSION The tri-parametric MRI provides additional value to the radiomics-based identification of MIS.
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Affiliation(s)
- Yan Liu
- School of Biomedical Engineering, Air Force Medical University, No. 169 Changle West Road, Xi'an, SN 710032, China; Shaanxi Provincial Key Laboratory of Bioelectromagnetic Detection and Intelligent Perception, Xi'an, SN 710032, China
| | - Xiaopan Xu
- School of Biomedical Engineering, Air Force Medical University, No. 169 Changle West Road, Xi'an, SN 710032, China; Shaanxi Provincial Key Laboratory of Bioelectromagnetic Detection and Intelligent Perception, Xi'an, SN 710032, China
| | - Huanjun Wang
- Department of Radiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, GD 510080, China
| | - Yang Liu
- School of Biomedical Engineering, Air Force Medical University, No. 169 Changle West Road, Xi'an, SN 710032, China; Shaanxi Provincial Key Laboratory of Bioelectromagnetic Detection and Intelligent Perception, Xi'an, SN 710032, China
| | - Yang Wang
- Department of Radiology, the First Affiliated Hospital, Air Force Medical University, Xi'an, SN 710032, China
| | - Qi Dong
- School of Biomedical Engineering, Air Force Medical University, No. 169 Changle West Road, Xi'an, SN 710032, China; Shaanxi Provincial Key Laboratory of Bioelectromagnetic Detection and Intelligent Perception, Xi'an, SN 710032, China
| | - Ziqi Li
- School of Biomedical Engineering, Air Force Medical University, No. 169 Changle West Road, Xi'an, SN 710032, China; Shaanxi Provincial Key Laboratory of Bioelectromagnetic Detection and Intelligent Perception, Xi'an, SN 710032, China
| | - Yan Guo
- Department of Radiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, GD 510080, China
| | - Hongbing Lu
- School of Biomedical Engineering, Air Force Medical University, No. 169 Changle West Road, Xi'an, SN 710032, China; Shaanxi Provincial Key Laboratory of Bioelectromagnetic Detection and Intelligent Perception, Xi'an, SN 710032, China.
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Huele EH, Veenboer PW, Wessels FJ, Jonges TN, Meijer RP. Value of multiparametric magnetic resonance imaging for local staging of invasive urinary bladder tumours. Urol Oncol 2023; 41:49.e7-49.e12. [PMID: 36441069 DOI: 10.1016/j.urolonc.2022.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Initial tumour staging in bladder cancer mainly relies on the histo-pathological outcome of the transurethral bladder tumour resection (TURBT) and imaging by means of a CT-scan (CT-intravenous urography; CT-IVU). The reported risk of understaging varies from 24-50%. To further improve the the evaluation of depth of invasion of the bladder tumour the application of magnetic resonance imaging (MRI) may be useful. To substantiate the additional value of this imaging modality the present observational study was designed. STUDY DESIGN This is a prospective observational study to analyse bladder tumour staging with multiparametric magnetic resonance imaging (mpMRI) in patients with a known bladder tumour, who are planned for radical cystectomy. STUDY POPULATION Patients with an invasive bladder cancer who are planned for radical cystectomy. INTERVENTION Patients were accrued during their visit to the outpatient department of urology. They underwent routine cystoscopy, laboratory tests (including serum Creatinin) and CT-IVU investigations and subsequently a mpMRI. MAIN STUDY PARAMETERS/ENDPOINTS To demonstrate the value of mpMRI in the initial staging of bladder tumours using radiological bladder tumour stage (T-stage) based on mpMRI and pathological bladder tumour stage based on 'whole-mount' histo-pathology after radical cystectomy. RESULTS Thirty-seven participants with known bladder tumours underwent mpMRI and subsequent cystectomy. After mpMRI 10 participants were diagnosed with non-muscle-invasive bladder cancer (NMIBC) and 27 participants with muscle-invasive bladder cancer (MIBC). In the 'whole-mount' pathology results 12 participants had NMIBC and 25 participants had MIBC. We found a sensitivity and specificity of 0.88 en 0.58 respectively, for the evaluation of MIBC. The positive and negative predictive value were 81% and 70% respectively. The diagnostic accuracy of mpMRI to differentiate between NMIBC and MIBC was 78%. CONCLUSIONS We found a sensitivity of 88% and a specificity of 58% for mpMRI to discriminate NMIBC from MIBC.
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Affiliation(s)
- Eline H Huele
- Department Oncological Urology, University Medical Center Utrecht, The Netherlands
| | - Paul W Veenboer
- Department Oncological Urology, University Medical Center Utrecht, The Netherlands
| | - Frank J Wessels
- Department Radiology, University Medical Center Utrecht, The Netherlands
| | - Trudy N Jonges
- Department Pathology, University Medical Center Utrecht, The Netherlands
| | - Richard P Meijer
- Department Oncological Urology, University Medical Center Utrecht, The Netherlands.
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Inter-reader reliability of the vesical imaging-reporting and data system (VI-RADS) for muscle-invasive bladder cancer: a systematic review and meta-analysis. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:4173-4185. [PMID: 36112202 DOI: 10.1007/s00261-022-03669-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/24/2022] [Accepted: 08/27/2022] [Indexed: 01/18/2023]
Abstract
To evaluate the diagnostic agreement between readers in VI-RADS interpretation to detect muscle-invasive bladder cancer (MIBC) preoperatively, we conducted a systematic review and meta-analysis of the available data. Scopus, PubMed, Web of Science, and Embase databases were systematically searched up to November 13, 2021. Case reports, review articles, editorials, and studies with insufficient data were eliminated. The Quality Appraisal of the Diagnostic Reliability Checklist was used to assess the risk of bias. The degree of agreement was determined by Cohen's kappa coefficient (κ) for comparison of data. The heterogeneity of these studies was explored using subgroup analysis and meta-regression analysis. The level of confidence was set at 0.05. All analyses were conducted in STATA 16.0. Overall, 19 eligible studies, consisting of 2439 participants, were included in this meta-analysis. The inter-reader agreement for VI-RADS in MIBC detection ranged from κ of 0.45 to 0.96 among included studies. The pooled inter-reader reliability was calculated as 0.76 [95% CI 0.73-0.80; I2 = 92.13%, Q(50) = 635.08, p < 0.01]. Sources of heterogeneity included magnetic strength, T2WI slice thickness, number of readers, sample size, study design, number of centers, year of publication, proportion of male patients, and mean age. There is substantial reliability in VI-RADS interpretation for MIBC among radiologists with various levels of expertise. The high degree of inter-reader agreement for MIBC detection supports the implementation of VI-RADS in routine clinical practice for the staging paradigm of bladder cancer.
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Wang W, Li W, Wang K, Wu J, Qiu J, Zhang Y, Zhang X, Wang H, Wang X. Integrating radiomics with the vesical imaging-reporting and data system to predict muscle invasion of bladder cancer. Urol Oncol 2022:S1078-1439(22)00424-0. [DOI: 10.1016/j.urolonc.2022.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/23/2022] [Accepted: 10/28/2022] [Indexed: 12/15/2022]
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Zou Y, Cai L, Chen C, Shao Q, Fu X, Yu J, Wang L, Chen Z, Yang X, Yuan B, Liu P, Lu Q. Multi-task deep learning based on T2-Weighted Images for predicting Muscular-Invasive Bladder Cancer. Comput Biol Med 2022; 151:106219. [PMID: 36343408 DOI: 10.1016/j.compbiomed.2022.106219] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 09/29/2022] [Accepted: 10/15/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND An accurate preoperative assessment of Non-Muscle-Invasive Bladder Cancer (NMIBC) and Muscle-Invasive Bladder Cancer (MIBC) in Bladder Cancer (BCa) can help the urologist make diagnostic decisions. Considering the absence of multiparametric MRI for contrast medium allergy and economic reasons, this study aims to develop a deep learning method based on T2-Weighted (T2WI) images alone for predicting NMIBC and MIBC. METHOD We propose a Multi-task BCa Muscular Invasion Prediction (MBMIP) model to discriminate MIBC from NMIBC. The three-channel-input including the original T2WI image, segmented bladder, and the region of interest can help the MBMIP model locate the bladder and pay more attention to the surrounding information of the tumor. Inception V3 is used as the feature extraction module, which uses multiple branches to extract high-level features with different degrees of abstraction. In addition, based on the idea of multi-task learning, a reconstruction block for T2WI images is also introduced to assist the backbone classification network to improve the classification performance. RESULTS The entire data consist of retrospective data (390 cases), prospective data (39 cases), and multi-center data (39 cases). In the retrospective test, the accuracy, sensitivity, and specificity of the MBMIP model are 0.911, 0.889, and 0.920 respectively, while those of the prospective test are 0.923, 1.000, and 0.885. And in the muti-center test, the MBMIP model yields accuracy, sensitivity, and specificity of 0.846, 0.667, and 0.879. CONCLUSION The MBMIP model could achieve a satisfactory prediction result in discriminating between NMIBC and MIBC, which may aid urologists in preoperative decision-making for BCa patients.
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Affiliation(s)
- Yuan Zou
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Lingkai Cai
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chunxiao Chen
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China.
| | - Qiang Shao
- Department of Urology, the Affiliated Suzhou Hospital of Nanjing Medical University, Nanjing, China.
| | - Xue Fu
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Jie Yu
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Liang Wang
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Zhiying Chen
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Xiao Yang
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Baorui Yuan
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Peikun Liu
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qiang Lu
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Noh TI, Shim JS, Kang SG, Sung DJ, Cheon J, Sim KC, Kang SH. Comparison between biparametric and multiparametric MRI in predicting muscle invasion by bladder cancer based on the VI-RADS. Sci Rep 2022; 12:20689. [PMID: 36450813 PMCID: PMC9712519 DOI: 10.1038/s41598-022-19273-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 08/26/2022] [Indexed: 12/05/2022] Open
Abstract
This study aimed to compare the diagnostic validity of biparametric magnetic resonance imaging (bpMRI) with that of multiparametric MRI (mpMRI) based on the Vesicle Imaging-Reporting and Data System (VI-RADS) in predicting muscle invasion by bladder cancer (BCa). We retrospectively examined 357 patients with an initial diagnosis of BCa who underwent preoperative MRI; 257 and 100 patients underwent mpMRI and bpMRI, respectively. Two urogenital radiologists evaluated all bpMRI and mpMRI scans using VI-RADS, and the diagnostic validity of VI-RADS for predicting muscle invasion by BCa was analyzed based on histopathology of the first and/or second transurethral resection of bladder tumors and radical cystectomy. Receiver operating characteristic (ROC) curves were plotted with the calculation of area under the curves (AUCs), and the level of significance was P < 0.05. Both groups showed optimal performance with a VI-RADS score ≥ 3. BpMRI showed comparable diagnostic performance to mpMRI (reader 1: AUC, 0.903 [0.827-0.954] vs. 0.935 [0.884-0.968], p = 0.510; and reader 2: AUC, 0.901 [0.814-0.945] vs. 0.915 [0.874-0.946]; p = 0.655). The inter-reader agreement between both readers was excellent (Cohen's kappa value = 0.942 and 0.905 for bpMRI and mpMRI, respectively). This comparative study suggests that bpMRI has comparable diagnostic performance to mpMRI and may be an alternative option to predict muscle invasion by BCa.
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Affiliation(s)
- Tae Il Noh
- Department of Urology, Anam Hospital, Korea University College of Medicine, 73 Goryeodae-Ro, Seongbuk-Gu, Seoul, 02841, Korea
| | - Ji Sung Shim
- Department of Urology, Anam Hospital, Korea University College of Medicine, 73 Goryeodae-Ro, Seongbuk-Gu, Seoul, 02841, Korea
| | - Sung Gu Kang
- Department of Urology, Anam Hospital, Korea University College of Medicine, 73 Goryeodae-Ro, Seongbuk-Gu, Seoul, 02841, Korea
| | - Deuk Jae Sung
- Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jun Cheon
- Department of Urology, Anam Hospital, Korea University College of Medicine, 73 Goryeodae-Ro, Seongbuk-Gu, Seoul, 02841, Korea
| | - Ki Choon Sim
- Department of Radiology, Anam Hospital, Korea University College of Medicine, Seoul, Korea.
| | - Seok Ho Kang
- Department of Urology, Anam Hospital, Korea University College of Medicine, 73 Goryeodae-Ro, Seongbuk-Gu, Seoul, 02841, Korea.
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El-Karamany TM, Al-Adl AM, Hosny MM, A Eldeep H, El-Hamshary SA. Clinical utility of vesical imaging-reporting and data system (VI-RADS) in non-muscle invasive bladder cancer (NMIBC) patients candidate for en-bloc transurethral resection: A prospective study. Urol Oncol 2022; 40:454.e1-454.e7. [PMID: 35466036 DOI: 10.1016/j.urolonc.2022.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/16/2022] [Accepted: 03/19/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To assess accuracy of vesical imaging-reporting and data system (VI-RADS) 5-point score in detection of muscle invasive bladder cancer and avoiding second look transurethral resection of the tumors (TURBT). Additionally, to assess safety and efficacy of bipolar en-block transurethral urethral resection of bladder tumor. METHODS Patients with bladder mass up to 5 cm were included in the study. VI-RADS 5-point score was done preoperative for all cases and postoperatively before second look TURBT. Patients were followed up for 12 months. RESULTS In all, 80 cases were eligible for the study. Preoperative VI-RADS score at cutoff of 3 had sensitivity of 89.3 %, specificity 83.3 %, postive predective value (PPV) 92.6 %, negative predictive value (NPV) 76.9 %, accuracy of 87.5 %, while at cutoff 2 sensitivity was 82.1%, specificity 91.7%, PPV 95.8%, NPV 68.8%, accuracy of 85.0%. Operative time 28.8 ± 9.4 minutes, hemoglobin drop 0.3 ± 0.05 g/dl, catheterization time 2.8 ± 0.8 days, hospital stay 1.4 ± 0.4 days. No complications occurred. Recurrence in field of resection 3.75%. Detrusor muscle was available in 76 cases (95%). Postoperative VI-RADS score at cutoff of 3 had sensitivity of 78.6%, specificity 77.8%, PPV 84.6%, NPV 70.0%, accuracy of 78.3%. At cutoff 2 VI-RADS score sensitivity was 71.4%, specificity 77.8%, PPV 83.3%, NPV 63.6%, accuracy of 73.9%. CONCLUSION VI-RADS 5-point score showed high sensitivity and specificity in preoperative discrimination of non-muscle invasive bladder cancer (NMIBC) from muscle invasive bladder cancer cases and in avoiding unnecessary second look TURBT. Bipolar en-block TURBT technique is both safe and efficacious in resecting NMIBC cases with low recurrence rate.
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Culpan M, Kazan O, Acar HC, Iplikci A, Atis G, Yildirim A. The probability of residual tumor detection in the second transurethral resection of pT1 urothelial bladder cancer according to the risk factors. Actas Urol Esp 2022; 46:423-430. [PMID: 35725972 DOI: 10.1016/j.acuroe.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/17/2021] [Accepted: 07/23/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To analyze the predictive factors for residual tumors in the second resection after the initial transurethral resection of bladder tumor (TUR-BT) in patients with pT1 tumors and to develop a simple method to predict the probability of residual tumor detection. MATERIAL AND METHODS Patients with pT1 bladder cancer who underwent a second resection within two to six weeks after the initial TUR-BT were included in our retrospective study. The patients' demographics and the tumor characteristics of the initial and second resections were recorded. RESULTS A total of 144 patients were included in our analysis with a 53-month follow-up. In the univariate logistic regression analysis, tumor grade, concomitant carcinoma in situ (CIS), macroscopic appearance of the tumor (solid vs papillary), and presence of a variant histology, were significant risk factors for residual tumor. In the multivariate analysis, tumor grade was the only independent predictor of residual tumor at second TUR (OR: 5.62, 95% CI: 1.228-25.708, p = 0.026). According to our findings, the patients with the highest risk have a 90.9% residual tumor detection probability at the second resection, and the patients with the lowest risk have 25.4%. CONCLUSIONS Tumor grade, macroscopic appearance of the tumor (solid vs papillary), and concomitant CIS, were important predictors of residual tumors at second resection of primary pT1 NMIBC patients. We were able to calculate the probability of residual tumor which helped us determine risk adapted strategies according to these probabilities.
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Affiliation(s)
- M Culpan
- Department of Urology, Istanbul Medeniyet University, Istanbul, Turkey.
| | - O Kazan
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - H Cansu Acar
- Department of Public Health, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - A Iplikci
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - G Atis
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - A Yildirim
- Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
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Huang X, Wang X, Lan X, Deng J, Lei Y, Lin F. The role of radiomics with machine learning in the prediction of muscle-invasive bladder cancer: A mini review. Front Oncol 2022; 12:990176. [PMID: 36059618 PMCID: PMC9428259 DOI: 10.3389/fonc.2022.990176] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
Bladder cancer is a common malignant tumor in the urinary system. Depending on whether bladder cancer invades muscle tissue, it is classified into non-muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC). It is crucial to accurately diagnose the muscle invasion of bladder cancer for its clinical management. Although imaging modalities such as CT and multiparametric MRI play an important role in this regard, radiomics has shown great potential with the development and innovation of precision medicine. It features outstanding advantages such as non-invasive and high efficiency, and takes on important significance in tumor assessment and laor liberation. In this article, we provide an overview of radiomics in the prediction of muscle-invasive bladder cancer and reflect on its future trends and challenges.
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Affiliation(s)
- Xiaodan Huang
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Xiangyu Wang
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Xinxin Lan
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Jinhuan Deng
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Yi Lei
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Fan Lin
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
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Bicchetti M, Simone G, Giannarini G, Girometti R, Briganti A, Brunocilla E, Cardone G, De Cobelli F, Gaudiano C, Del Giudice F, Flammia S, Leonardo C, Pecoraro M, Schiavina R, Catalano C, Panebianco V. 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. LA RADIOLOGIA MEDICA 2022; 127:881-890. [PMID: 35763251 PMCID: PMC9349064 DOI: 10.1007/s11547-022-01513-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 06/01/2022] [Indexed: 11/25/2022]
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.
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Affiliation(s)
- Marco Bicchetti
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161, Rome, Italy
| | - Giuseppe Simone
- Department of Urology, 'Regina Elena' National Cancer Institute, IRCCS, Rome, Italy
| | - Gianluca Giannarini
- Unit of Urology, Santa Maria della Misericordia Academic Medical Center, Udine, Italy
| | - Rossano Girometti
- Institute of Radiology, Santa Maria della Misericordia Academic Medical Center, Udine, Italy
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS Vita-Salute San Raffaele University, Milan, Italy
| | | | - Gianpiero Cardone
- Department of Radiology, IRCCS Ospedale San Raffaele Di Turro, Milan, Italy
| | - Francesco De Cobelli
- Department of Radiology, IRCSS Vita-Salute San Raffaele University, Milan, Italy
| | | | - Francesco Del Giudice
- Department of Maternal-Infant and Urological Sciences, Sapienza University/Policlinico Umberto I, Rome, Italy
| | - Simone Flammia
- Department of Maternal-Infant and Urological Sciences, Sapienza University/Policlinico Umberto I, Rome, Italy
| | - Costantino Leonardo
- Department of Maternal-Infant and Urological Sciences, Sapienza University/Policlinico Umberto I, Rome, Italy
| | - Martina Pecoraro
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161, Rome, Italy
| | | | - Carlo Catalano
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161, Rome, Italy
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University/Policlinico Umberto I, Viale Regina Elena 324, 00161, Rome, Italy.
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Active surveillance for non-muscle-invasive bladder cancer: fallacy or opportunity? Curr Opin Urol 2022; 32:567-574. [DOI: 10.1097/mou.0000000000001028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Comparison of reduced field-of-view DWI and full field-of view DWI for the differentiation between non-muscle invasive bladder cancer and muscle invasive bladder cancer using VI-RADS. PLoS One 2022; 17:e0271470. [PMID: 35857788 PMCID: PMC9299291 DOI: 10.1371/journal.pone.0271470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 06/29/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate whether reduced field-of-view (rFOV) DWI sequence improves the differentiation between non-muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC) using VI-RADS. Material and methods Eighty-nine patients underwent bladder MRI with full field-of-view (fFOV) DWI and rFOV DWI sequence. Images were independently evaluated by 2 radiologists. The sensitivities, specificities, accuracies, and areas under the curve (AUCs) for the differentiation between NMIBC and MIBC with fFOV DWI and with rFOV DWI sequence were calculated using VI-RADS. Apparent diffusion coefficients (ADC) values were measured for each patient and averaged. Results The sensitivity, specificity, accuracy, and AUC by reader 1 were 92%, 78%, 82% and 0.905 with fFOV DWI, and 92%, 86%, 88% and 0.916 with rFOV DWI sequence, respectively. The sensitivity, specificity, accuracy and AUC by reader 2 were 96%, 76%, 82% and 0.900 with conventional DWI, and 96%, 81%, 85% and 0.907 with rFOV DWI sequence, respectively. The specificity and accuracy of reader 1 were significantly better with rFOV DWI sequence than with fFOV DWI, in contrast there was no significant difference for the others. The average of ADC values of fFOV DWI and rFOV DWI sequence were 1.004×10−6 mm2/s and 1.003×10−6 mm2/s, respectively. Conclusion The diagnostic ability of rFOV DWI sequence may be better than that of fFOV DWI using VI-RADS for the differentiation between NMIBC and MIBC regardless of image-reading experience, it is controversial.
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Wu Q, Cai L, Yuan B, Cao Q, Zhuang J, Bao M, Wang Z, Feng D, Tao J, Li P, Shao Q, Yang X, Lu Q. The application value of multi-parameter cystoscope in improving the accuracy of preoperative bladder cancer grading. BMC Urol 2022; 22:111. [PMID: 35850869 PMCID: PMC9295426 DOI: 10.1186/s12894-022-01054-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/04/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To develop and validate a preoperative cystoscopic-based predictive model for predicting postoperative high-grade bladder cancer (BCa), which could be used to guide the surgical selection and postoperative treatment strategies. MATERIALS AND METHODS We retrospectively recruited 366 patients with cystoscopy biopsy for pathology and morphology evaluation between October 2010 and January 2021. A binary logistic regression model was used to assess the risk factors for postoperative high-grade BCa. Diagnostic performance was analyzed by plotting receiver operating characteristic curve and calculating area under the curve (AUC), sensitivity, specificity. From January 2021 to July 2021, we collected 105 BCa prospectively to validate the model's accuracy. RESULTS A total of 366 individuals who underwent transurethral resection of bladder tumor (TURBT) or radical cystectomy following cystoscopy biopsy were included for analysis. 261 (71.3%) had a biopsy pathology grade that was consistent with postoperative pathology grade. We discovered five cystoscopic parameters, including tumor diameter, site, non-pedicled, high-grade biopsy pathology, morphology, were associated with high-grade BCa. The established multi-parameter logistic regression model ("JSPH" model) revealed AUC was 0.917 (P < 0.001). Sensitivity and specificity were 86.2% and 84.0%, respectively. And the consistency of pre- and post-operative high-grade pathology was improved from biopsy-based 70.5% to JSPH model-based 85.2%. In a 105-patients prospective validation cohort, the consistency of pre- and post-operative high-grade pathology was increased from 63.1 to 84.2% after incorporation into JSPH model for prediction. CONCLUSION The cystoscopic parameters based "JSPH model" is accurate at predicting postoperative pathological high-grade tumors prior to operations.
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Affiliation(s)
- Qikai Wu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People's Republic of China
| | - Lingkai Cai
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People's Republic of China
| | - Baorui Yuan
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People's Republic of China
| | - Qiang Cao
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People's Republic of China
| | - Juntao Zhuang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People's Republic of China
| | - Meiling Bao
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People's Republic of China
| | - Zhen Wang
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People's Republic of China
| | - Dexiang Feng
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People's Republic of China
| | - Jun Tao
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People's Republic of China
| | - Pengchao Li
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People's Republic of China
| | - Qiang Shao
- Department of Urology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, 215008, People's Republic of China.
| | - Xiao Yang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People's Republic of China.
| | - Qiang Lu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People's Republic of China.
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The use of MRI in urothelial carcinoma. Curr Opin Urol 2022; 32:536-544. [DOI: 10.1097/mou.0000000000001011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Das JP, Woo S, Ghafoor S, Andrieu PC, Ulaner GA, Donahue TF, Goh AC, Vargas HA. Value of MRI in evaluating urachal carcinoma: A single center retrospective study. Urol Oncol 2022; 40:345.e9-345.e17. [DOI: 10.1016/j.urolonc.2022.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/07/2022] [Accepted: 02/26/2022] [Indexed: 11/25/2022]
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Nicola R, Pecoraro M, Lucciola S, Dos Reis RB, Narumi Y, Panebianco V, Muglia VF. VI-RADS score system - A primer for urologists. Int Braz J Urol 2022; 48:609-622. [PMID: 35195385 PMCID: PMC9306377 DOI: 10.1590/s1677-5538.ibju.2021.0560] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 12/24/2022] Open
Abstract
Bladder cancer (BCa) is one of the most common cancers worldwide and is also considered to be one of the most relapsing and aggressive neoplasms. About 30% of patients will present with muscle invasive disease, which is associated with a higher risk for metastatic disease. The aim of this article is to review the state of art imaging in Radiology, while providing a complete guide to urologists, with case examples, for the rationale of the development of the Vesical Imaging Reporting and Data System (VI-RADS), a scoring system emphasizing a standardized approach to multiparametric Magnetic Resonance Imaging (mpMRI) acquisition, interpretation, and reporting for BCa. Also, we examine relevant external validation studies and the consolidated literature of mpMRI for bladder cancer. In addition, this article discusses some of the potential clinical implications of this scoring system for disease management and follow-up.
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Affiliation(s)
- Refky Nicola
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Martina Pecoraro
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Italy
| | - Sara Lucciola
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Italy
| | - Rodolfo Borges Dos Reis
- Departamento de Cirurgia, Divisão de Urologia - Faculdade de Medicina de Ribeirão Preto - USP, Ribeirão Preto, SP, Brasil
| | | | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Italy
| | - Valdair Francisco Muglia
- Departamento de Imagens Médicas, Oncologia e Hematologia - Divisão de Imagem, Faculdade de Medicina de Ribeirão Preto - USP, Ribeirão Preto, SP, Brasil
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Abstract
Although cystoscopic biopsy is the standard of care for initial diagnosis and local staging of bladder cancer, radiologic imaging plays a major role in identifying local invasion, nodal status, distant metastasis, and posttreatment surveillance. Recent development of the Vesical Imaging-Reporting and Data System for interpretation of multiparametric magnetic resonance imaging of the bladder has expanded the role diagnostic imaging in the management of bladder cancer. This article reviews multimodality imaging appearances, staging, and differential diagnosis of bladder cancer.
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