To compare the diagnostic performance of the Ovarian-Adnexal Reporting and Data System (O-RADS), the risk of malignancy index 4 (RMI4), the International Ovarian of Tumor Analysis logistic regression model 2 (IOTA LR2) and IOTA simple rule (IOTA SR) in predicting the malignancy of adnexal masses (AMs).Methods: This was a retrospective study of 575 women with AMs between 2017 and 2020. All clinical messages, ultrasound images, and pathological findings were collected. Two senior doctors (Group I) and two junior doctors (Group II) used the four systems to classify AMs. The postoperative pathological diagnosis was used as the gold standard to evaluate the diagnostic efficiency. Receiver operating characteristic curve was used to test the diagnostic performance.The interrater agreement between the two groups was tested by the kappa value.Results: Of all 592 AMs, 447 (75.5%) tumors were benign, 123 (20.8%) were malignant, and 22 (3.7%) were borderline. The intergroup consistency test yielded kappa values of 0.71, 0.92, 0.68 and 0.77 for the O-RADS, RMI4, IOTA LR2 and IOTA SR, respectively. To predict malignant lesions, the areas under the curve of the O-RADS, RMI4, IOTA LR2 and IOTA SR systems were 0.90, 0.89, 0.90 and 0.86 for Group I and 0.89, 0.87, 0.88 and 0.84 for Group II, respectively. The O-RADS had the highest sensitivity of 91.0% in Group I and 84.8% in Group II. Conclusion:The four diagnostic systems could compensate for junior doctors' inexperience in predicting malignant adnexal lesions. The O-RADS performed best with the highest sensitivity.

Introduction and hypothesis The objective was to describe the behaviour of the bladder neck and proximal urethra during urine leaking in the cough stress test (CST) in supine and standing positions using transperineal ultrasound (TPUS). Method We carried out prospective data collection and a retrospective data analysis of 102 women with stress urinary incontinence (SUI) who had a positive CST with TPUS in the supine and/or standing position. On TPUS, the behaviour of the bladder neck and proximal urethra was described by the urethral length, urethral funnelling, bladder neck descent (BND), retrovesical angle (RVA) and urethral rotation angle (URA). Differences between the ultrasound findings in the two positions were evaluated. Results In the 102 women, the mean age was 48 years and mean BMI was 23.8 kg/m 2. On TPUS, urine leakage was detected in the supine or standing position in 102 women and in both positions in 81. Between the two positions, significant differences were found in the URA and RVA. In the standing position, the median RVA of 166°was significantly larger than that of 133°in the supine position (p < 0.001), and the median URA of 35°was significantly smaller than that of 64°in the supine position (p < 0.001). Conclusions TPUS in both positions can be used to detect the real-time behaviour of the bladder neck and urethra in the CST. In the standing position, less rotation and more straightening of the bladder neck and proximal urethra occurred during urine leakage.

Objectives-To describe the ultrasonographic signs of ovarian collision tumors and evaluate the malignancy risk using the O-RADS system.Methods-This 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.Results-The 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.Conclusions-The 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.