Catherine H. Phillips

The Ovarian/Adnexal Reporting and Data System for Ultrasound: From Standardized Terminology to Optimal Risk Assessment and Management

The American College of Radiology (ACR) Ovarian-Adnexal Reporting and Data System (O-RADS) lexicon and risk assessment tool for ultrasound (US) provides a framework for characterization of ovarian and adnexal pathology with the ultimate goal of harmonizing reporting and patient management strategies. Since the first O-RADS US publication in 2018, multiple validation studies have shown O-RADS US to have excellent diagnostic accuracy, with the majority of these studies using O-RADS 4 as the optimal cut-off for detecting ovarian cancer. Most of the existing validation studies include a dedicated training phase and confirm that ORADS US categories and lexicon descriptors are associated with high level inter-read agreement, regardless of radiologist training level or practice experience. O-RADS US has a similar inter-reader agreement when compared to Gynecologic Imaging Reporting and Data System (GIRADS), Assessment of Different Neoplasias in the adnexa (ADNEX), and International Tumor Analysis Group (IOTA) simple rules. System descriptors have been shown to correlate with expected malignancy rates and the O-RADS US risk stratification system has been shown to perform in the expected range of malignancy risk per category. Further directions will focus on clarifying governing concepts and lexicon terminology as well as further refining risk stratification categories based on data from published validation studies.

Incidental Adnexal Lesions: CT Diagnosis and Interreader Agreement

Even among nine expert readers, CT diagnosis was not reproducible and was frequently incorrect for most adnexal lesion types, excluding dermoids, malignant ovarian lesions with metastases, and simple cysts.

The Ovarian-Adnexal Reporting and Data System (O-RADS) US Score Effect on Surgical Resection Rate

Among ovarian and adnexal lesions surgically removed before 2015, a large proportion were retrospectively assessed as Ovarian-Adnexal Imaging Reporting and Data System US 2, which may have allowed for more conservative management in these patients.

The Roles of Ovarian-Adnexal Reporting and Data System US and Ovarian-Adnexal Reporting and Data System MRI in the Evaluation of Adnexal Lesions

Ovarian-Adnexal Reporting and Data System US and MRI provide evidence-based lexicons and risk assessment systems that can accurately diagnose most adnexal lesions as benign and effectively risk stratify those that are suspicious for malignancy.