Experts share 4 concerns with O-RADS recommendations

The Ovarian-Adnexal Reporting and Data System was introduced to improve clinicians’ consistency and accuracy when assessing adnexal masses. And after a trio of experts implemented such a system at their own institution, they came back with a few reservations. 

Elizabeth Suh-Burgmann, MD, with Kaiser Permanente Northern California, and colleagues developed an O-RADS system that has been used to report ultrasound-based risk for more than 30,000 women with adnexal masses. And while they agree that there is standardization needed for managing these findings, the group expressed a handful of concerns with the system.

They shared four “reservations” in a letter to the editor, published Feb. 25 in Radiology.

1). Masses considered low and intermediate risk are recommended for MRI. But Suh-Burgmann and co-editorialists argued that there is no prospective, community-based research showing that MRI improves clinical outcomes in groups with low cancer prevalence. “Therefore, its cost effectiveness for triage in these settings is questionable, and raises concerns about potential added risks of incidental findings,” they wrote.

2). In O-RADS 3 and 4 lesions (low and intermediate risk), repeat ultrasound is not included as a management option. The authors noted, however, that such a strategy is the most commonly used approach for secondary evaluations of lower-risk adnexal masses, and can help avoid surgery in some cases.

3). The authors believe there is a disconnect between what is considered low-risk by ovarian cancer experts and how it is defined according to O-RADS. The latter considers a cancer low-risk if its risk is 1% to less than 10%. Suh-Burgmann et al. wrote that a woman with a 9% risk for the disease wouldn’t generally be deemed low-risk. They pointed to women with BRCA2 mutations who are considered high-risk under a lifetime lens.  

4). O-RADS was developed for patients at average-risk. At the same time, it was based on International Ovarian Tumor Analysis data, which is taken from preoperative ultrasound in high-risk European patients. This seems “incongruent,” the authors noted, and may inflate observed risk.

The O-RADS scoring system was recently validated for reporting ovarian and uterine masses on MRI. The earliest iteration of the score was first published in a 2013 version of Radiology as the AdnexMR score. After revisions, it was released to a wider audience in a study published last November in Radiology.

Suh-Burgmann concluded their letter by agreeing with authors of the November study, who pushed for further research to test O-RADS. But they added that validation is needed in community settings with lower cancer prevalence because “these are the settings in which the overwhelming majority of adnexal masses are detected.”