Lieming Wen

Comparison of the diagnostic efficiency between the O-RADS US risk stratification system and doctors’ subjective judgment

Abstract Background This study aimed to compare the diagnostic efficiency of Ovarian-Adnexal Reporting and Data System (O-RADS) and doctors’ subjective judgment in diagnosing the malignancy risk of adnexal masses. Methods This was an analysis of 616 adnexal masses between 2017 and 2020. The clinical findings, preoperative ultrasound images, and pathological diagnosis were recorded. Each adnexal mass was evaluated by doctors’ subjective judgment and O-RADS by two senior doctors and two junior doctors. A mass with an O-RADS grade of 1 to 3 was a benign tumor, and a mass with an O-RADS grade of 4–5 was a malignant tumor. All outcomes were compared with the pathological diagnosis. Results Of the 616 adnexal masses, 469 (76.1%) were benign, and 147 (23.9%) were malignant. There was no difference between the area under the curve of O-RADS and the subjective judgment for junior doctors (0.83 (95% CI: 0.79–0.87) vs. 0.79 (95% CI: 0.76–0.83), p = 0.0888). The areas under the curve of O-RADS and subjective judgment were equal for senior doctors (0.86 (95% CI: 0.83–0.89) vs. 0.86 (95% CI: 0.83–0.90), p = 0.8904). O-RADS had much higher sensitivity than the subjective judgment in detecting malignant tumors for junior doctors (84.4% vs. 70.1%) and senior doctors (91.2% vs. 81.0%). In the subgroup analysis for detecting the main benign lesions of the mature cystic teratoma and ovarian endometriosic cyst, the junior doctors’ diagnostic accuracy was obviously worse than the senior doctors’ on using O-RADS. Conclusions O-RADS had excellent performance in predicting malignant adnexal masses. It could compensate for the lack of experience of junior doctors to a certain extent. Better performance in discriminating various benign lesions should be expected with some complement.

Ultrasound Findings andO‐RADSMalignancy Risk Stratification of Ovarian Collision Tumors

ObjectivesTo describe the ultrasonographic signs of ovarian collision tumors and evaluate the malignancy risk using the O‐RADS system.MethodsThis was a retrospective analysis of 25 ovarian collision tumors from 8739 patients between May 2010 and January 2020. All clinical characteristics, ultrasound images, and histological findings were collected and analyzed. Using the O‐RADS lexicon descriptors, the O‐RADS score was determined by two senior doctors. Lesions with O‐RADS scores of 1 to 3 were classified as benign tumors, and lesions with O‐RADS scores of 4 to 5 were classified as malignant tumors.ResultsThe mean age of the 25 patients was 30.4 years. Histological findings showed that all tumors were a combination of mature cystic teratomas and cystadenomas/cystadenocarcinomas. There were 11 benign tumors of O‐RADS 2 or 3, including 3 uniocular cysts, 3 dermoid cysts, and 5 dermoid cysts with an anechoic fluid cavity. There were 12 benign tumors of O‐RADS 4, including 3 uniocular–multilocular cysts with solid components, 2 multilocular cysts with irregular walls, and 8 multilocular cysts with dermoid sacs. One borderline tumor of O‐RADS 4 was a multilocular cyst with irregular septation. One malignant tumor of O‐RADS 5 was a multilocular cystic tumor with solid components and ascites.ConclusionsThe most common ovarian collision tumor was the coexistence of a mature cystic teratoma and a cystadenoma. The O‐RADS system was able to sensitively detect malignant tumors in this series. A typical dermoid cyst with an anechoic cavity or a multilocular cyst with a dermoid sac may signify a benign collision tumor.