Accuracy of Vesical Imaging-Reporting and Data System for muscle-invasive bladder cancer detection from multiparametric magnetic resonance imaging.

PURPOSE: The Vesical Imaging-Reporting and Data System (VI-RADS) was used to distinguish the invasive nature of bladder masses before surgery. These imaging criteria can be used to carefully select patients who are candidates for repeat transurethral resection of bladder tumor (Re-TUR-BT). One-third of patients are understage at the time of Re-TUR-BT. This study aimed to evaluate the discrimination accuracy of VI-RADS between non-muscle-invasive bladder cancer and muscle-invasive bladder cancer. MATERIALS AND METHODS: Patients with a bladder mass identified by cystoscopy who were assigned for TUR-BT were offered multiparametric magnetic resonance imaging (mpMRI) for VI-RADS. TUR-BT reports were compared with preoperative VI-RADS scores to evaluate the accuracy of discrimination of the muscle-invasive nature of the bladder mass. RESULTS: A total of 58 bladder tumor lesions were included, 13 with muscle-invasive bladder cancer and 45 with non-muscle-invasive bladder cancer. Sensitivity and specificity were 92.3% and 86.7%, respectively, when a VI-RADS cutoff of 4 or more was used to define muscle-invasive bladder cancer. Positive predictive value and negative predictive value were 66.7% and 97.5%, with an accuracy of 87.9%. The area under the receiver operating characteristic curve was 0.932 (95% confidence interval, 0.874-0.989), and the empirical optimal cutpoint from the Youden method was 3. CONCLUSIONS: VI-RADS is an accurate tool for correctly differentiating muscle-invasive bladder cancer from non-muscle-invasive bladder cancer. We found a cutpoint of VI-RADS 1-3 vs. 4-5 to have the highest specificity and accuracy for the discrimination of non-muscle-invasive from muscle-invasive bladder cancer.

The prevalence and risk factors of upgrading of Gleason grade group between transrectal ultrasound prostate biopsy and prostatectomy specimens.

Background: The risk stratification of prostate cancer using Gleason grade group (GG), serum prostate-specific antigen (PSA), and T staging has an important role for appropriate treatment. In fact, the GG of biopsy was not the same as the prostatectomy specimen. The upgrading of GG has a significant risk of delay treatment. The study aims to evaluate the concordance of GG between biopsy and prostatectomy specimens and the factors of upgrading GG. Materials and Methods: Retrospectively reviewed data from January 2010 to December 2019, 137 patients underwent prostate biopsy and followed by prostatectomy. Patients' data include pathological reports, imaging reports, serum PSA, PSA density (PSAD), and free PSA were analyzed by univariate and multivariate analysis. Results: The concordance between the pathology was found in 54 specimens (39.4%) with the upgrading of GG in the prostatectomy was 57 specimens (41.6%). Furthermore, the downgrading was 26 specimens (18.9%). Serum PSA >10 ng/ml (P 0.003), PSAD >0.2 ng/ml/cm3 (P 0.002), free/total PSA ratio (P 0.003), margin positive for malignancy (P 0.033), and extraprostatic involvement (P 0.039) were significantly related with upgrading at the univariate analysis. Only a PSAD >0.2 (P 0.014) was found to be an independent factor that is predictive of upstaging in multivariate analysis. Conclusions: The prevalence of upgrading of GG from prostate biopsy to radical prostatectomy is as high as the other study. The factor that related to upstaging of GG was PSAD. Therefore, additional tools for biopsy were required to enhance the accurate diagnosis and staging of prostate cancer.