Ovarian-Adnexal Reporting and Data System for Ultrasound: A Framework for Improvement

Levine, Deborah; Patel, Maitray D.

doi:10.1177/08465371221126045

Cited by 2 publications

(4 citation statements)

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“…In the US at present, about 9.1 surgeries are performed to detect 1 patient with ovarian cancer . The problem of balancing sensitivity and specificity in ultrasonography models is even more apparent in populations with lower malignant tumor prevalence, which influences PPVs and thus increases false-positive results . Ultimately, the physician and the patient have to consider the risks and benefits of any procedure and determine the individual cutoff in the specific circumstances in which the adnexal mass is evaluated.…”

Section: Discussionmentioning

confidence: 99%

“…In 2019, based on the IOTA terms and data sets, the American College of Radiology (ACR) introduced the Ovarian-Adnexal Reporting and Data System (O-RADS) model, which also provides management recommendations (Figure 1). However, neither of the IOTA models were widely adopted in the US, and the O-RADS system was only recently introduced with limited uptake . Challenging the use of standardized models were findings showing that subjective expert assessment had the highest accuracy .…”

Section: Introductionmentioning

confidence: 99%

“…However, neither of the IOTA models were widely adopted in the US, and the O-RADS system was only recently introduced with limited uptake. 1,[22][23][24] Challenging the use of standardized models were findings showing that subjective expert assessment had the highest accuracy. 18 However, acquiring such expertise in reviewing pelvic sonograms requires extensive training and may not be possible in low-volume practices.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic Performance of Ultrasonography-Based Risk Models in Differentiating Between Benign and Malignant Ovarian Tumors in a US Cohort

et al. 2023

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ImportanceUltrasonography-based risk models can help nonexpert clinicians evaluate adnexal lesions and reduce surgical interventions for benign tumors. Yet, these models have limited uptake in the US, and studies comparing their diagnostic accuracy are lacking.ObjectiveTo evaluate, in a US cohort, the diagnostic performance of 3 ultrasonography-based risk models for differentiating between benign and malignant adnexal lesions: International Ovarian Tumor Analysis (IOTA) Simple Rules with inconclusive cases reclassified as malignant or reevaluated by an expert, IOTA Assessment of Different Neoplasias in the Adnexa (ADNEX), and Ovarian-Adnexal Reporting and Data System (O-RADS).Design, Setting, and ParticipantsThis retrospective diagnostic study was conducted at a single US academic medical center and included consecutive patients aged 18 to 89 years with adnexal masses that were managed surgically or conservatively between January 2017 and October 2022.ExposureEvaluation of adnexal lesions using the Simple Rules, ADNEX, and O-RADS.Main Outcomes and MeasuresThe main outcome was diagnostic performance, including area under the receiver operating characteristic (ROC) curve (AUC), sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios. Surgery or follow-up were reference standards. Secondary analyses evaluated the models’ performances stratified by menopause status and race.ResultsThe cohort included 511 female patients with a 15.9% malignant tumor prevalence (81 patients). Mean (SD) ages of patients with benign and malignant adnexal lesions were 44.1 (14.4) and 52.5 (15.2) years, respectively, and 200 (39.1%) were postmenopausal. In the ROC analysis, the AUCs for discriminative performance of the ADNEX and O-RADS models were 0.96 (95% CI, 0.93-0.98) and 0.92 (95% CI, 0.90-0.95), respectively. After converting the ADNEX continuous individualized risk into the discrete ordinal categories of O-RADS, the ADNEX performance was reduced to an AUC of 0.93 (95% CI, 0.90-0.96), which was similar to that for O-RADS. The Simple Rules combined with expert reevaluation had 93.8% sensitivity (95% CI, 86.2%-98.0%) and 91.9% specificity (95% CI, 88.9%-94.3%), and the Simple Rules combined with malignant classification had 93.8% sensitivity (95% CI, 86.2%-98.0%) and 88.1% specificity (95% CI, 84.7%-91.0%). At a 10% risk threshold, ADNEX had 91.4% sensitivity (95% CI, 83.0%-96.5%) and 86.3% specificity (95% CI, 82.7%-89.4%) and O-RADS had 98.8% sensitivity (95% CI, 93.3%-100%) and 74.4% specificity (95% CI, 70.0%-78.5%). The specificities of all models were significantly lower in the postmenopausal group. Subgroup analysis revealed high performances independent of race.Conclusions and RelevanceIn this diagnostic study of a US cohort, the Simple Rules, ADNEX, and O-RADS models performed well in differentiating between benign and malignant adnexal lesions; this outcome has been previously reported primarily in European populations. Risk stratification models can lead to more accurate and consistent evaluations of adnexal masses, especially when used by nonexpert clinicians, and may reduce unnecessary surgeries.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Diagnostic Performance of Ultrasonography-Based Risk Models in Differentiating Between Benign and Malignant Ovarian Tumors in a US Cohort

et al. 2023

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“…In this month’s Journal, Drs. Levine and Patel provide a thoughtful editorial 1 on our review of the ACR Ultrasound (US) Ovarian-Adnexal Reporting and Data System (O-RADS). 2 We sincerely appreciate their feedback, commendation, and focused suggestions, many of which have already been addressed in the recent release of O-RADS US v2022.…”

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Response to Editorial Entitled: Ovarian-Adnexal Reporting and Data System for Ultrasound: A Framework for Improvement

et al. 2023

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Ovarian-Adnexal Reporting and Data System for Ultrasound: A Framework for Improvement

Cited by 2 publications

References 5 publications

Diagnostic Performance of Ultrasonography-Based Risk Models in Differentiating Between Benign and Malignant Ovarian Tumors in a US Cohort

Diagnostic Performance of Ultrasonography-Based Risk Models in Differentiating Between Benign and Malignant Ovarian Tumors in a US Cohort

Response to Editorial Entitled: Ovarian-Adnexal Reporting and Data System for Ultrasound: A Framework for Improvement

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