The Ovarian/Adnexal Reporting and Data System for Ultrasound: From Standardized Terminology to Optimal Risk Assessment and Management

Abstract

The American College of Radiology (ACR) Ovarian-Adnexal Reporting and Data System (O-RADS) lexicon and risk assessment tool for ultrasound (US) provides a framework for characterization of ovarian and adnexal pathology with the ultimate goal of harmonizing reporting and patient management strategies. Since the first O-RADS US publication in 2018, multiple validation studies have shown O-RADS US to have excellent diagnostic accuracy, with the majority of these studies using O-RADS 4 as the optimal cut-off for detecting ovarian cancer. Most of the existing validation studies include a dedicated training phase and confirm that ORADS US categories and lexicon descriptors are associated with high level inter-read agreement, regardless of radiologist training level or practice experience. O-RADS US has a similar inter-reader agreement when compared to Gynecologic Imaging Reporting and Data System (GIRADS), Assessment of Different Neoplasias in the adnexa (ADNEX), and International Tumor Analysis Group (IOTA) simple rules. System descriptors have been shown to correlate with expected malignancy rates and the O-RADS US risk stratification system has been shown to perform in the expected range of malignancy risk per category. Further directions will focus on clarifying governing concepts and lexicon terminology as well as further refining risk stratification categories based on data from published validation studies.

CAR Practice Statement on Advanced Pelvic Ultrasound for Endometriosis

“…For adenomyosis, refer to the MUSA statement; 28 for fibroids, refer to the FIGO classification system; 29 and for ovarian masses, refer to ACR O-RADS™. 30,31…”

“…For adenomyosis, refer to the MUSA statement; 28 for fibroids, refer to the FIGO classification system; 29 and for ovarian masses, refer to ACR O-RADSÔ. 30,31 With respect to the bowel, it is essential for potential surgical planning to include information on the number and size of lesions(s) (measurements in 3 orthogonal places), the distance between lesions if there are multiple, and the distance between the lowest aspect of the most caudal bowel lesion and the anal verge. 33,34 The location of the bowel can be described using sections that are measured from the anal verge.…”

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

“…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. 3 Nonetheless, we are grateful for this opportunity to respond to their specific points.…”

“…However, recent large cohort IOTA 5 data, 5 including surveillance of benign-appearing lesions, showed no significant change in risk from earlier IOTA 1-3 data. Validation within a nonselected population has demonstrated expected O-RADS performance, 6 and while most validation studies show the ROM for categories 3 and 4 to be at the lower end, 2 the addition of features associated with benignity in O-RADS v2022 aims to improve specificity; these include bilocular for cysts and shadowing for smooth solid lesions. 3…”

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

“…Ovarian-Adnexal Reporting and Data System for Ultrasound: A Framework for Improvement Deborah Levine, MD 1 and Maitray D. Patel, MD 2 In this month's Journal, Dr Phillips and colleagues 1 review the nascent Ultrasound (US) Ovarian-Adnexal Reporting and Data System (O-RADS) categorization and management system. Tables reproduced from the original articles 2 nicely summarize the lexicon, risk categorization categories, and suggested management of adnexal masses that form the framework of US O-RADS, and the authors provide commentary to explain the origins of the system; this initial portion of the article will be of most value to readers not yet wellversed with O-RADS.…”