Photo Credit: Elena Merkulova

The following is a summary of “Need for a second transurethral resection in high-risk non-muscle-invasive bladder cancer based on the Vesicle Imaging–Reporting and Data System,” published in the December 2024 issue of Urology by Nakamura et al. 

Vesical Imaging–Reporting and Data System (VI-RADS) has not been fully validated for guiding second transurethral resection (TUR) in high-risk non-muscle-invasive bladder cancer (NMIBC). Its effectiveness in detecting residual tumors remains unclear. 

Researchers conducted a retrospective study to evaluate the utility of VI-RADS in patients with high-risk NMIBC requiring a second TUR.  

They retrospectively analyzed 116 high-risk patients with NMIBC who underwent magnetic resonance imaging (MRI) prior to the initial TUR and a second TUR. MRI images were classified according to VI-RADS, and second TUR outcomes, recurrence-free survival (RFS) and progression-free survival (PFS) rates were compared with VI-RADS scores. 

The results showed that 99 (91%) patients were diagnosed with T1 bladder cancer at initial TUR. At second TUR, residual cancer was found in 53 (49%) cases, including 5 (4.6%) with muscle invasion. The 2-year bladder RFS rate was 71%, and the 2-year PFS rate was 85%. VI-RADS classifications were 30 (28%), 49 (45%), 16 (15%),10 (9.2%), 4 (3.7%). Of 5 pT2 upstage cases, 3 were VI-RADS 1, 1 was VI-RADS 2, and 1 was VI-RADS 3. No significant association was found between VI-RADS and residual cancer or pT2 upstage rates, recurrence-free, or PFS rates. 

They concluded that a second TUR is necessary in patients with high-risk NMIBC, regardless of VI-RADS scores. VI-RADS did not predict outcomes or survival rates. 

Source: onlinelibrary.wiley.com/doi/abs/10.1111/iju.15638