University of Florida College of Medicine - Jacksonville
Introduction: Extramural venous invasion (EMVI) identified on magnetic resonance imaging (MRI) is a known biomarker for adverse pathology in rectal cancer, but not yet studied in bladder cancer (BCa). In this study, we explored the feasibility of identifying EMVI in patients with BCa and its utility in detecting adverse pathology. Methods: After obtaining IRB approval, the MRI findings including EMVI were reported in consecutive BCa patients with available imaging between January 2018 and June 2020 (Figure 1). EMVI was correlated with adverse pathologic features of the pathology specimens, including lymphovascular invasion (LVI), variant histology, muscle invasive bladder cancer (MIBC), and extravesical disease (EV). Inferential statistics and logistic regression were performed for data analysis. Results: A total of 38 patients were enrolled in the study, with a median age of 73 years (range 50-101). 29 (76%) patients in the study cohort were male. EMVI was identified in 23 (62%) patients. There was a significant association between EMVI and MIBC (OR= 5.30, CI= 1.11- 25.36; p= 0.036), as well as EV (OR= 17.77, CI= 2.37- 133; p= 0.005). There was a clear trend between EMVI and presence of LVI (OR= 4.89, CI 0.92-26.1; p = 0.06), as well as EMVI and histologic variant (OR= 16.38 CI= 0.77- 348; p= 0.07) (Table 1). EMVI had sensitivity, specificity, negative predictive (NPV) and positive predictive (PPV) values of 90%, 73%, 94% and 63% respectively in detecting EV. Most interestingly, EMVI had 100% sensitivity and NPV for histologic variants. Conclusions: According to our pilot study results, EMVI, a novel imaging biomarker for BCa, is associated with adverse pathology. We propose that EMVI may be incorporated into standardized MRI reporting systems. SOURCE OF Funding: none
.jpg "Allison Feibus, MD,MS photo")
