RESUMO
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.
RESUMO
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.