A novel reporting system can accurately stratify the risk of indeterminate adnexal masses on sonograms and can help physicians design a patient-centered approach for treating ovarian and uterine masses.
The Ovarian-Adnexal Reporting Data System Magnetic Resonance Imaging (O-RADS MRI) score is a five-point system for categorizing indeterminate masses. The first iteration of the score was published in a 2013 version of Radiology as the AdnexMR score. Now, with the help of the American College of Radiology, a group of international researchers has tested and validated the system in a multicenter prospective study that included more than 1,000 women, sharing their results Jan. 24 in JAMA Network Open.
“The findings provide the evidence to support the publication of the O-RADS MRI score version 1,” first author Isabelle Thomassin-Naggara, MD, PhD, and colleagues wrote. “Using this score in clinical practice may allow a tailored, patient-centered approach for masses that are sonographically indeterminate, preventing unnecessary surgery, less extensive surgery or fertility preservation when appropriate, while ensuring preoperative detection of lesions with a high likelihood of malignancy,” they added later.
Adnexal masses are common and can lead to further imaging, surgery and pathology workload-related costs, Thomassin-Naggara, with Sorbonne Universite in Paris, and colleagues wrote. Most are benign and can be categorized as such on ultrasonography, but between 18% and 31% of these masses remain indeterminate according to other commonly used ultrasonography scoring systems.
For their study, the team enrolled 1,194 eligible women who received a pelvic MRI at one of 15 referral centers in order to diagnose an indeterminate adnexal mass. Performed over a three-year period, two on-site readers applied O-RADS to the cases while another did so without clinical and ultrasonographic data.
Overall, the system was accurate at stratifying masses, achieving a 0.93 sensitivity and 0.91 specificity. And the study showed “substantial” interrater agreement, regardless of how experienced the radiologist was. This, the authors noted, had been a challenge in some ultrasonographic studies.
Beyond accurately classifying hard-to-distinguish masses, the system could be used to create a clinical decision-support tool to refer patients for appropriate follow-up or surgery, and help young patients with early-stage disease adhere to fertility-preserving treatment options, the authors wrote.
The scoring system was not integrated into clinical decision-making, but validating its accuracy allows researchers to perform two further studies—already ongoing—to test the consequences of the O-RADS MRI score in treatment planning, Thomassin-Naggara wrote.