SES AUA 2022: Extramural Venous Invasion: A Novel Magnetic Resonance Imaging Biomarker For Adverse Pathology In Bladder Cancer

The 2022 Southeastern Section of the AUA’s annual meeting included a bladder cancer session and Dr. Allison Feibus discussing extramural venous invasion as a novel MRI biomarker for adverse pathology in bladder cancer. Extramural venous invasion identified on MRI is a known biomarker for adverse pathology in rectal cancer, but not yet studied in bladder cancer. In this study, Dr. Feibus and colleagues explored the feasibility of identifying extramural venous invasion in patients with bladder cancer and its utility in detecting adverse pathology.

The MRI findings, including extramural venous invasion, was reported in consecutive bladder cancer patients with available imaging, between January 2018 and June 2020. Extramural venous invasion was correlated with adverse pathologic features of the pathology specimens, including lymphovascular invasion, variant histology, muscle invasive bladder cancer, and extravesical disease. Inferential statistics and logistic regression were used for analysis. As follows is a representative image of a coronal high resolution T2 weighted and post contrast T1 weighted gradient scan showing extramural vascular invasion:

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The following figure shows the vessels adjacent to the bladder dome, showing irregular contour, nodular expansion, with definite tumor signal:

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There were 38 patients enrolled in the study, with a median age of 73 years (range 50-101) and 76% male. There were 22 patients (58%) with muscle invasive bladder cancer (16 patients, 42% with non-muscle-invasive bladder cancer), and 9 patients (24%) had histologic variants. Overall, extramural venous invasion was identified in 23 (62%) patients. There was a significant association between extramural venous invasion and muscle invasive bladder cancer (OR 5.30, 95% CI 1.11- 25.36), as well as the extravesical disease (OR 17.77, 95% CI 2.37- 133). Additionally, there was a trend between extramural venous invasion and presence of lymphovascular invasion (OR 4.89, 95% CI 0.92-26.1) and histologic variant (OR 16.38, 95% CI 0.77- 348). The full multivariable model assessing predictors of extramural venous invasion is as follows:

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Extramural venous invasion had a sensitivity, specificity, negative predictive value, and positive predictive value of 90%, 73%, 94% and 63%, respectively, in detecting extravesical disease. Most interestingly, extramural venous invasion had 100% sensitivity and negative predictive value for histologic variants.

Dr. Feibus concluded her presentation assessing the feasibility of identifying extramural venous invasion in patients with bladder cancer and its utility in detecting adverse pathology with the following take-home messages:
• This is the first pilot study assessing MRI extramural venous invasion
• According to these results, extramural venous invasion, a novel imaging biomarker for bladder cancer, is associated with adverse pathology
• Extramural venous invasion can be potentially incorporated in standardized MRI reporting systems (ie. VI-RADS):

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Presented By: Allison Feibus, MD, Department of Urology, University of Florida, Jacksonville college of medicine, Jacksonville, FL

Co-Authors: Soroush Bazargani, MD1, Dheeraj Reddy Gopire, MD2, Ashley Way, MD3, SeyedBehzad Jazayeri, MD4, Jatinder Kumar, MD1, Muhammad Umar Alam, MD1, Hariharan Palyapalayam Ganapathi, MD4, Joseph Costa, DO4, Mark Bandyk, MD4, Shahriar Koochekpour, MD4, Shiva Gautam, MD5, Chandana Lall, MD6, K.C. Balaji, MD4

Affiliations: 1Department of Urology, University of Florida, Jacksonville college of medicine, Jacksonville, FL., 2Department of Radiology, University of Florida, Jacksonville College of Medicine, Jacksonville, Fl, 3Department of Radiology, University of Florida, Jacksonville College of Medicine, Jacksonville, F, 4Department of Urology, University of Florida, Jacksonville college of medicine, Jacksonville, FL, 5Department of Biostatistics, University of Florida, Jacksonville, FL., 6Department of Radiology, University of Florida, Jacksonville College of Medicine

Written By: Zachary Klaassen, MD, MSc – Urologic Oncologist, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, @zklaassen_md on Twitter during the 86th Annual Meeting of the Southeastern Section of the American Urological Association, San Juan, PR, Mar 16 – 19, 2022