Diagnostic accuracy and inter-reader agreement of the nacVI-RADS for bladder cancer treated with neoadjuvant chemotherapy: a prospective validation study.

IF 4.7 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

European Radiology Pub Date : 2025-07-01 Epub Date: 2024-12-31 DOI:10.1007/s00330-024-11327-w

Ailin Dehghanpour, Martina Pecoraro, Emanuele Messina, Ludovica Laschena, Antonella Borrelli, Simone Novelli, Daniele Santini, Giuseppe Simone, Rossano Girometti, Valeria Panebianco

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引用次数: 0

Abstract

Objective: The primary aim was to determine the performance of neoadjuvant chemotherapy VI-RADS (nacVI-RADS) in predicting response to systemic therapy in patients with MIBC and to evaluate its inter-reader agreement.

Materials and methods: Prospective study, including patients with non-metastatic muscle-invasive bladder cancer (MIBC) who underwent neoadjuvant chemotherapy before radical cystectomy (RC). Patients underwent pre- and post-treatment MRI. Radiological response was evaluated by two experienced radiologists using nacVI-RADS scoring system. Reference standard was defined using histopathological findings. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy were calculated to assess nacVI-RADS performance for each reader. Inter-reader agreement was determined with Cohen's k statistics.

Results: Fifty-five patients with non-metastatic MIBC, 46 males (84%) and 9 females (16%) with a median age of 69 (interquartile range (IQR) 66-72 years) were enrolled. Diagnostic performance of nacVI-RADS in detecting complete response to neoadjuvant chemotherapy showed a sensitivity of 76.5-85.3% and specificity of 76.2-81%. The area under the curve was 0.93 (95% CI: 0.86-0.99) for detecting any residual tissue, for the more experienced reader. Inter-reader agreement was optimal with a K of 0.85. In the multivariable logistic regression model, the variables showing independent correlation with response prediction to neoadjuvant therapy were nacVI-RADS score (p = 0.01 for the more experienced reader) and tumor regression grade (TRG; p < 0.001).

Conclusion: NacVI-RADS scoring system offers a reliable and reproducible approach, employing a well-structured and easily interpretable method, to assess the response to systemic therapy in patients with MIBC.

Key points: Question There is a lack of a standardized approach to distinguish between responders and non-responders to neoadjuvant chemotherapy for muscle-invasive bladder cancer. Findings The neoadjuvant chemotherapy VI-RADS (nacVI-RADS) score diagnostic performance for detecting complete response to neoadjuvant chemotherapy showed 85.3% sensitivity, 81% specificity, and an AUC of 0.93. Clinical relevance NacVI-RADS score represents a valid predictor of response to neoadjuvant systemic therapy, impacting therapeutic decision-making and improving overall patients' management.

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nacVI-RADS对新辅助化疗治疗膀胱癌的诊断准确性和读者间一致性：一项前瞻性验证研究。

目的：主要目的是确定新辅助化疗VI-RADS （nacVI-RADS）在预测MIBC患者对全身治疗的反应方面的表现，并评估其读者间一致性。材料和方法：前瞻性研究，包括在根治性膀胱切除术（RC）前接受新辅助化疗的非转移性肌肉浸润性膀胱癌（MIBC）患者。患者接受治疗前和治疗后的MRI检查。放射反应由两名经验丰富的放射科医生使用nacVI-RADS评分系统进行评估。根据组织病理学结果确定参比标准。计算敏感性、特异性、阴性预测值（NPV）、阳性预测值（PPV）和准确性，以评估每个阅读器的nacVI-RADS性能。读者间的一致性由Cohen的k统计量决定。结果：55例非转移性MIBC患者，46例男性（84%）和9例女性（16%），中位年龄为69岁（四分位间距（IQR） 66-72岁）。nacVI-RADS检测新辅助化疗完全缓解的敏感性为76.5-85.3%，特异性为76.2-81%。对于更有经验的读者，检测任何残留组织的曲线下面积为0.93 （95% CI: 0.86-0.99）。读者间一致性最佳，K值为0.85。在多变量logistic回归模型中，与新辅助治疗反应预测独立相关的变量为nacVI-RADS评分（较有经验的阅读者p = 0.01）和肿瘤消退等级(TRG；结论：NacVI-RADS评分系统提供了一种可靠且可重复的方法，采用结构良好且易于解释的方法来评估MIBC患者对全身治疗的反应。目前缺乏一种标准化的方法来区分对肌肉浸润性膀胱癌新辅助化疗有反应和无反应的患者。发现新辅助化疗VI-RADS （nacVI-RADS）评分检测新辅助化疗完全缓解的诊断性能敏感性为85.3%，特异性为81%，AUC为0.93。临床相关性NacVI-RADS评分是对新辅助全身治疗反应的有效预测指标，影响治疗决策并改善整体患者管理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Radiology 医学-核医学

CiteScore

11.60

自引率

8.50%

发文量

874

审稿时长

2-4 weeks

期刊介绍： European Radiology (ER) continuously updates scientific knowledge in radiology by publication of strong original articles and state-of-the-art reviews written by leading radiologists. A well balanced combination of review articles, original papers, short communications from European radiological congresses and information on society matters makes ER an indispensable source for current information in this field. This is the Journal of the European Society of Radiology, and the official journal of a number of societies. From 2004-2008 supplements to European Radiology were published under its companion, European Radiology Supplements, ISSN 1613-3749.