VI-RADS联合肿瘤基底...肌层浸润性膀胱癌的价值研究_陈如串.pdf

260欢迎关注本刊公众号中国癌症杂志2023年第33卷第3期 CHINA ONCOLOGY 2023 Vol.33 No.3论 著VI-RADS联合肿瘤基底接触长度检测肌层浸润性膀胱癌的价值研究陈如串1，2，刘伟2，周冰妮2，刘晓航2，周良平1，21.上海市影像医学研究所，上海 200032；2.复旦大学附属肿瘤医院放射诊断科，复旦大学上海医学院肿瘤学系，上海 200032摘要 背景与目的：基于多参数磁共振成像（magnetic resonance imaging，MRI）的膀胱影像报告和数据系统（Vesical Imaging-Reporting and Data System，VI-RADS）在术前评估膀胱癌肌层浸润方面的价值越来越得到认可，但当以3分为诊断阈值时仍存在较高的假阳性率。肿瘤大小在肿瘤浸润评估方面具有一定的辅助诊断价值。因此本研究旨在探究VI-RADS联合肿瘤大小用于评估膀胱癌肌层浸润方面的诊断效能。方法：回顾性收集2019年11月2022年2月复旦大学附属肿瘤医院收治的119例经手术后病理学检查证实为膀胱癌患者（共159个病灶）的术前膀胱多参数MRI及临床资料。由两名放射科医师独立对每个病灶进行VI-RADS评分以及肿瘤基底接触长度（tumor contact length，TCL）的测量，对于评分或大小存在差异的病灶由两名医师讨论后达成一致结论。采用受试者工作特征（receiver operating characteristic，ROC）曲线分析VI-RADS、TCL及两者联合模型的肌层浸润诊断效能，在计算出相应的曲线下面积（area under curve，AUC）、灵敏度、特异度、阳性预测值（positive predictive value，PPV）、阴性预测值（negative predictive value，NPV）和诊断准确度后进行比较。结果：术后病理学检查证实，非肌层浸润性膀胱癌（non-muscle-invasive bladder cancer，NMIBC）和肌层浸润性膀胱癌（muscle-invasive bladder cancer，MIBC）病灶分别为75和84个。MIBC组平均TCL（6.15 6.23 cm）与NMIBC组平均TCL（2.26 2.35 cm）存在显著差异，差异有统计学意义（P0.05）。VI-RADS联合TCL在预测膀胱癌肌层浸润方面的特异度、PPV及诊断准确度均显著高于单独应用以3分为诊断阈值的VI-RADS（P0.05），但灵敏度和NPV差异无统计学意义（P0.05）。TCL（AUC=0.89）、VI-RADS（AUC=0.90）及VI-RADS联合TCL（AUC=0.91）的AUC差异无统计学意义（P0.05）。结论：VI-RADS联合TCL能够在一定程度上降低VI-RADS 3分病灶在评价膀胱癌肌层浸润方面的假阳性率，有利于避免过度治 疗。关键词 膀胱影像报告和数据系统；肿瘤基底接触长度；肌层浸润性膀胱癌；磁共振成像中图分类号：R737.14 文献标志码：ADOI:10.19401/ki.1007-3639.2023.03.009The value of VI-RADS combined with tumor contact length in the detection of muscle-invasive bladder cancer CHEN Ruchuan1,2,LIU Wei2,ZHOU Bingni2,LIU Xiaohang2,ZHOU Liangping1,2(1.Shanghai Institute of Medical Imaging,Shanghai 200032,China;2.Department of Radiology,Fudan University Shanghai Cancer Center,Department of Oncology,Shanghai Medical College,Fudan University,Shanghai 200032,China)Correspondence to:ZHOU Liangping,E-mail:zhoulp_.Abstract Background and purpose:The value of Vesical Imaging-Reporting and Data System(VI-RADS)based on multiparametric magnetic resonance imaging(MRI)in the preoperative assessment of bladder cancer muscle-invasive is increasingly recognized.However,there is still a high number of false positives when the diagnostic cut-off value is 3 points.Tumor size has certain auxiliary diagnostic value in the assessment of tumor infiltration.Therefore,this study mainly explored the diagnostic performance of VI-RADS combined with tumor size in assessing bladder cancer muscle-invasive.Methods:The preoperative bladder multiparametric MRI and clinical data of 119 patients with bladder cancer confirmed by surgery and pathology(a total of 159 lesions)who were treated in Fudan University Shanghai Cancer Center from November 2019 to February 2022 were retrospectively 第一作者：陈如串（ORCID:0000-0001-9030-9746），硕士在读。通信作者：周良平（ORCID:0000-0001-7051-5868），博士，主任医师，E-mail:zhoulp_。261中国癌症杂志2023年第33卷第3期collected.VI-RADS score and tumor contact length(TCL)measurements were performed independently for each lesion by two radiologists.Lesions with differences in score or size were given consistent results following discussion by two physicians.The receiver operating characteristic(ROC)curve was used to analyze the diagnostic performance of VI-RADS,TCL and their combined models for muscle invasion,and the corresponding area under curve(AUC),sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV)and diagnostic accuracy were compared.Results:Postoperative pathology confirmed that there were 75 and 84 lesions of non-muscle-invasive bladder cancer(NMIBC)and muscle-invasive bladder cancer(MIBC),respectively.The mean TCL of MIBC group(6.15-6.23 cm)was significantly different from that of NMIBC group(2.26-2.35 cm),and the difference was statistically significant(P0.05).The specificity,PPV and diagnostic accuracy of VI-RADS combined with TCL in predicting bladder cancer muscle-invasive were significantly higher than those of VI-RADS with a diagnostic threshold of 3 points alone(P0.05),whereas there was no statistically significant difference in the sensitivity and NPV(P0.05).There was no significant difference in AUC between TCL(AUC=0.89),VI-RADS(AUC=0.90)and VI-RADS combined with TCL(AUC=0.91)(P0.05).Conclusion:VI-RADS combined with TCL can reduce the false positive rate of VI-RADS 3-point lesions in the evaluation of bladder cancer muscle-invasive to a certain extent,which is beneficial for avoiding overtreatment.Key words Vesical Imaging-Reporting and Data System;Tumor contact length;Muscle-invasive bladder cancer;Magnetic resonance imaging膀 胱 尿 路 上 皮 癌 是 泌 尿 系 统 常 见 的 肿瘤之一，其中肌层浸润性膀胱癌（muscle-invasive bladder cancer，MIBC）的5年生存率为60%70%，且约50%的患者会发生远处转移，给患者带来了较大的心理及经济负担 1-2。研究 3指出，膀胱癌治疗方案的选择和患者的预后与膀胱肌层是否受到侵犯密切相关。膀胱癌肌层浸润状况是决定膀胱癌患者治疗方法和预后的重要因素，对于非MIBC（non-MIBC，NMIBC）患者，临床上主要以保守治疗为主，如经尿道膀胱肿瘤电切术（transurethral resection of bladder tumors，TURBT），在保留膀胱的同时可提高患者的生活质量。对于MIBC患者，一般以膀胱根治术为主，根据病理学检查结果及患者意愿，辅以放疗、化疗、免疫治疗及靶向治疗等，患者不仅要面对膀胱切除对其精神状态和生活质量的影响，可能还会受到尿道造瘘口处反复感染的 困扰 3。多参数磁共振成像（magnetic resonance imaging，MRI）是一种无创性检查，具有良好的软组织分辨率，对于肿瘤浸润深度的评估比较直观。2018年欧洲泌尿外科协会提出以多参数MRI为基础建立膀胱影像报告和数据系统（Vesical Imaging-Repo