Letter to the Editor: “Prospective assessment of VI-RADS score in multiparametric MRI in bladder cancer: accuracy and the factors affecting the results”
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Abdominal Imaging - Letter to the Editor
P: 412-413
March 2023

Letter to the Editor: “Prospective assessment of VI-RADS score in multiparametric MRI in bladder cancer: accuracy and the factors affecting the results”

Diagn Interv Radiol 2023;29(2):412-413
1. Department of Radiology, Pamukkale University Faculty of Medicine, Denizli, Turkey
No information available.
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Received Date: 07.04.2022
Accepted Date: 30.05.2022
Publish Date: 29.03.2023
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Dear Editor,

We read the article titled “Prospective assessment of VI-RADS score in multiparametric MRI in bladder cancer: accuracy and the factors affecting the results” by Oğuz et al.1, published online in Diagnostic and Interventional Radiology. We congratulate the authors on this prospective magnetic resonance imaging (MRI) study in patients with bladder cancer. We want to make a few contributions and comments on this research article.

First, it is noteworthy that the number of cases accepted on the Vesical Imaging Reporting and Data System (VI-RADS) 3, according to the MRI evaluation in this study, was considerably higher than the studies in the current literature.2,3,4,5,6 The proportion of patients with a VI-RADS score of 3 in Oğuz et al.’s1 study was 38.75%. However, in prospective studies in the current literature, the proportion of patients with a VI-RADS score of 3 was 13.4% in Del Giudice et al.’s2 study, 18.2% in Erkoc et al.’s3 study, 6.9% in Metwally et al.’s4 study, 19.2%–20.5% in Akcay et al.’s5 study, and 8.8%–18.7% in Ueno et al.’s6 study. Moreover, Oğuz et al.1 reported that 93.5% (29/31) of the patients with a score of VI-RADS 3 had histopathologically non-muscle invasive bladder cancer, which is quite different from the literature. Many studies have shown that bladder tumors with a VI-RADS 3 score are in the gray zone and can indicate muscle-invasive and non-muscle-invasive bladder cancer at a similar rate. For example, Metwally et al.4 reported that of the 24 patients with a VI-RADS score of 3, 13 (54.2%) had histopathologically non-muscle invasive bladder cancer, while 11 (45.8%) had muscle-invasive bladder cancer. Similarly, Akcay et al.5 reported that of the 15 patients with a VI-RADS score of 3, 7 (46.7%) had histopathologically non-muscle invasive bladder cancer, while 8 (53.3%) had muscle-invasive bladder cancer. We suggest that this difference between the literature and Oguz et al.’s1 study may be due to an MRI assessment error.

Second, Oğuz et al.1 reported that the second observer for interobserver agreement evaluated only 20 random patients. However, the VI-RADS scores of these 20 patients were not specified. According to our clinical practice, the VI-RADS scores of the tumors are very important in terms of the interobserver agreement. For example, an excellent interobserver agreement is expected in evaluating tumors with a VI-RADS score of 1 or 5. In contrast, a significant decrease in the agreement is scheduled for those with a VI-RADS score of 3. Therefore, the authors need to indicate the VI-RADS scores of the 20 patients they evaluated.1

Finally, the authors noted that patients without muscle tissue in the transurethral resection of bladder tumor (TUR-BT) sample underwent a second TUR-BT after the first resection but did not specify the number or proportion of these patients. Akcay et al.5 reported that 10 of 83 patients (12%) had insufficient TUR-BT. We suggest that reporting the number of inadequate TUR-BT procedures in this study will contribute to the literature.1