Assessment of ultrasound ovarian-adnexal reporting & data system (O-RADS) for pediatric patients
Abstract
Background
Ovarian-Adnexal Reporting & Data System Ultrasound (O-RADS US) is a validated scoring system in adult women with adnexal lesions to help assess the risk of potential malignancy. Limited data exists for children in whom malignancy is rare.
Objective
To evaluate inter-radiologist agreement and diagnostic performance when using the O-RADS US in pediatric patients with ovarian lesions.
Materials and methods
Retrospective IRB-approved study included pelvic ultrasounds (US) from 2015 to 2020 in pediatric patients (<18 years). Pelvic US with ovarian lesions measuring >3 cm in premenarchal patients and >5 cm in menarchal patients were included. Three pediatric radiologists reviewed each US and recorded imaging characteristics and O-RADS classification. Diagnostic performance was assessed, and agreement among radiologists was calculated.
Results
In total, 160 pelvic US exams were included in 160 patients, with a mean patient age of 12.1 years (SD=4.9). Most lesions were classified as O-RADS 2 (almost certainly benign), and fewer cases as O-RADS 4 (intermediate risk) or O-RADS 5 (high risk). Inter-radiologist agreement for O-RADS category was moderate ( κ =0.42). Diagnostic performance of US O-RADS demonstrated high sensitivity and NPV (100% for all three reviewers). Specificities were 74-82%, and PPV was low at 5-7% for distinguishing malignant/borderline lesions from benign lesions.
Conclusions
Application of the O-RADS US system in pediatric patients may be challenging due to the low overall malignancy rate. Nevertheless, an O-RADS 2 classification provides meaningful reassurance, reflecting minimal malignancy risk in children. Larger studies are needed to determine the clinical utility of O-RADS US and whether pediatric-specific modifications are required.