Comparison of multiparametric bladder MRI and transurethral resection pathology results in patients with bladder mass detected on urinary ultrasonography

In our study, we aimed to determine the VI-RADS results of patients who applied to our clinic and had a bladder mass detected in their ultrasnographic imaging by performing a multiparametric bladder MRI, to compare these results with the pathological examination results of the cystoscopy and resection materials performed on the patient, and thus to reveal the relationship between VI-RADS results and clinical staging and to contribute to the literature. Materials and Methods: Hematuria, dysuria, pollakiuria, etc. were reported to Van Yüzüncü Yıl University Faculty of Medicine Dursun Odabaş Medical Center Urology Clinic between January 2020 and August 2024. 50 patients who applied with complaints, aged between 25 and 80, who had a mass detected in the bladder on urinary ultrasonography(USG) imaging, who underwent pathological sampling as a result of multiparametric bladder MR imaging and transurethral bladder resection or cystoscopy after the mass was detected on USG, and who met the inclusion criteria were included in the study. The data were collected retrospectively. According to the pathology results, t staging was performed according to the American Joint Committee on Cancer 2017 TNM classification, and these results were correlated with MRI results. Results: A total of 50 patients, 41 male and 9 female, were included in our study. The age range of the patients ranged from 25 to 80, with the average female age being 61.67 and the average male age being 62.63, while the overall average age was 62.46. There were 10 patients with multiparametric MRI results of VIRADS5 (median age 66.5), 6 with VIRADS4 (median age 68.33), 2 with VIRADS3 (median age 42.50), 10 with VIRADS2 (median age 59.20), 8 with VIRADS1 (median age 57.75) and 14 with VIRADS0 (median age 64.93). As age increased, higher values were observed in the VIRADS category, but this was not found to be statistically significant (p>0.05). Among all patients, the number of patients with invasive (T2 and above) pathology results was 15 (11 males, 4 females), the number of patients with non-invasive results was 21 (20 males, 1 female) and the number of patients with clean results was 14 (10 males, 4 females). Of the patients with invasive results, 73.3% were male and 26.7% were female. Pathology results of male patients were 26.8% invasive, 48.8% non-invasive and ix 24.4% clean. In female patients, these results were 44.4% invasive, 11.1% non-invasive and 44.4% clean. Although the number of male patients with invasive pathology results was higher than the number of female patients and the invasiveness rate was higher in female patients, these results were not found to be statistically significant (p=0.084). When pathology results were examined according to age, 2 non-invasive results were found between the ages of 25-40, 3 invasive, 11 non-invasive, 4 clean results were found between the ages of 41-60, and 12 invasive, 8 non-invasive, 10 clean results were found between the ages of 61-80. Although the number of patients with invasive pathology results increased with age, this was not found to be statistically significant (p=0.072). When we look at gender status according to age, there were 1 male and 1 female patient between the ages of 25-40, 15 male and 3 female patients between the ages of 41-60, and 25 male and 5 female patients between the ages of 61-80. Although the number of patients in both genders increased as age increased, male patients were generally observed in greater numbers than female patients and no statistically significant result was found (p=0.485). When we look at the relationship between VIRADS results and gender, there were 7 male and 3 female patients in the VIRADS5 group, 5 male and 1 female patient in the VIRADS4 group, 1 male and 1 female patient in the VIRADS3 group, 10 male patients in the VIRADS2 group, 8 male patients in the VIRADS1 group, and 10 male and 4 female patients in the VIRADS0 group. The relationship between VIRADS results and gender was not found to be statistically significant (p=0.194). When we look at VIRADS status according to age, there was 1 VIRADS3 and 1 VIRADS2 result between the ages of 25-40. There were 2 VIRADS5, 2 VIRADS4, 1 VIRADS3, 5 VIRADS2, 4 VIRADS1 and 4 VIRADS0 results between the ages of 41 60. There were 8 VIRADS5, 4 VIRADS4, 4 VIRADS2, 4 VIRADS1 and 10 VIRADS0 results between the ages of 61-80. As age increased, VIRADS5, VIRADS4 and VIRADS0 results increased, but this was not found to be statistically significant (p=0.06). When we look at the pathology results with VIRADS results, there were 10 invasive results in the VIRADS5 group, but no patients with non-invasive or clear results. There were 5 invasive and 1 non-invasive results in the VIRADS4 group, but no patients with clean results. There were 2 non-invasive results in the VIRADS3 group, but no patients with invasive or clear results. There were 10 non-invasive results in the x VIRADS2 group, but no patients with invasive or clear results. There were 8 non invasive results in the VIRADS1 group, but no patients with invasive or clear results. There were 14 clean results in the VIRADS0 group, but no patients with invasive or non-invasive results. While 100% invasiveness was detected in the VIRADS5 group, 83.3% invasiveness and 16.7% non-invasiveness were detected in the VIRADS4 group. 100% non-invasiveness was detected in all three groups VIRADS3, VIRADS2 and VIRADS1. In the VIRADS0 group, 100% pathology results were found to be clear and the findings are detailed in Table 9. The relationship between VIRADS results and pathology results was found to be statistically significant (p=0.001 and chi square=95.238). Conclusion: There are a limited number of studies in the literature comparing VIRADS criteria with pathology results in patients with bladder cancer. These studies generally aimed to determine the place and importance of VIRADS criteria in determining T staging of bladder cancer. In our study comparing VIRADS criteria and pathology results in patients with bladder mass detected on ultrasound, it was seen that VIRADS4 5 group was associated with T2 and above stage invasive bladder cancer, VIRADS3-2-1 group was associated with T2 and below stage non-invasive bladder cancer and VIRADS0 group was compatible with non-tumor pathology results. These results were found to be statistically significant (p=0.001). This information shows that VIRADS criteria may play a role in predicting clinical staging in patients with bladder cancer. In this way, we believe that our study can form the basis for more comprehensive multicenter studies in the future, and with these studies, less invasive applications can be used in bladder cancer staging and clinical staging can be done more accurately. In this respect, we believe that we have made a valuable contribution to the literature.