O-RADS US Risk Stratification and Management System: A Consensus Guideline from the ACR Ovarian-Adnexal Reporting and Data System Committee

Abstract

The Ovarian-Adnexal Reporting and Data System (O-RADS) US risk stratification and management system is designed to provide consistent interpretations, to decrease or eliminate ambiguity in US reports resulting in a higher probability of accuracy in assigning risk of malignancy to ovarian and other adnexal masses, and to provide a management recommendation for each risk category. It was developed by an international multidisciplinary committee sponsored by the American College of Radiology and applies the standardized reporting tool for US based on the 2018 published lexicon of the O-RADS US working group. For risk stratification, the O-RADS US system recommends six categories (O-RADS 0-5), incorporating the range of normal to high risk of malignancy. This unique system represents a collaboration between the pattern-based approach commonly used in North America and the widely used, European-based, algorithmic-style International Ovarian Tumor Analysis (IOTA) Assessment of Different Neoplasias in the Adnexa model system, a risk prediction model that has undergone successful prospective and external validation. The pattern approach relies on a subgroup of the most predictive descriptors in the lexicon based on a retrospective review of evidence prospectively obtained in the IOTA phase 1-3 prospective studies and other supporting studies that assist in differentiating management schemes in a variety of almost certainly benign lesions. With O-RADS US working group consensus, guidelines for management in the different risk categories are proposed. Both systems have been stratified to reach the same risk categories and management strategies regardless of which is initially used. At this time, O-RADS US is the only lexicon and classification system that encompasses all risk categories with their associated management schemes.

Ultrasound, macroscopic and histological features of serous epithelial ovarian carcinomas

“…Moreover, the tumor was classified as O-RADS 5. 2 At laparoscopy, ultrasound findings were confirmed. An intraoperative frozen section of the right ovarian mass was positive for high grade serous ovarian carcinoma.…”

“…Moreover, the tumor was classified as O-RADS 5. 2 Laparoscopy confirmed bilateral ovarian masses and multiple peritoneal nodules. A right salpingo-oophorectomy, peritoneal biopsies, and peritoneal washing were performed.…”

Accuracy in Referrals to Gynecologic Oncologists Based on Clinical Presentation for Ovarian Mass

“…Tumor markers also do not play a role in the evaluation; however, this should be individualized per patient. O-RADS is the only system that provides clear indications to refer to gynecologic oncologists and incudes risk categories as well as associated management [15]. However, O-RADS score is not yet standard on imaging reports in the United States.…”

GIRADS: método de clasificación de masas anexiales, revisión sistemática y metanálisis. 10 años de experiencia

“…Además, O-RADS incorpora la Resonancia Nuclear Magnética como elemento de segunda línea en caso de duda, esquema difícilmente aplicable en forma masiva en muchas realidades incluyendo la nuestra. Aun así, los autores, en la discusión, califican como decepcionante la especificidad del sistema propuesto 43,44 . La baja especificidad, se repite en otros trabajos y es una limitación que a menudo, se pasa por alto.…”