O-RADS: A new reporting system for ovarian, uterine masses

An international committee has developed a new data and reporting system to bring consistency and accuracy to assessing ovarian masses and lumps within uterine tissue.

The Ovarian-Adnexal Reporting and Data System (O-RADS) was created based on vocabulary published in 2018 by the O-RADS ultrasound working group and guidelines established by the International Ovarian Tumor Analysis (IOTA) group. Sponsored by the American College of Radiology, the tool recommends six categories (O-RADS scores 0 through 5) to distinguish the risk of malignancy, and combines a common North American approach with a widely used European algorithmic technique.

“The accurate characterization of ovarian and other adnexal masses is essential for optimal patient management,” Rochelle F. Andreotti, MD, with Vanderbilt University College of Medicine, and colleagues wrote.

The researchers outlined eight governing concepts pertaining to O-RADS risk stratification on ultrasound and patient management in an Nov. 5 statement, published in Radiology.

They are summarized below:

1. O-RADS recommendations should be used as guidance rather than requirements.

2. The system is based on average-risk patients without acute symptoms and no risk factors for ovarian cancer, which include a “significant” family history of such cancer or the BRCA gene.

3. Bringing in an ultrasound specialist is an option when using O-RADS, but there is no current guideline to define that specific type of specialist.

4. Every patient must receive a pre- or post-menopausal designation.

5. Clinicians must measure the largest diameter of the lesion in order to understand its size.

6. O-RADS should only be used for ovarian or fallopian tube lesions, with exceptions for certain pelvic lesions.

7. Recommendations are most often based on transvaginal sonography, but may be changed via transabdominal or transrectal sonography.

8. When analyzing multiple lesions, each should be characterized separately and managed according to lesions with the highest O-RADS score.

“The American College of Radiology Ovarian-Adnexal Reporting and Data System (O-RADS) committee believes that the objective has been met to provide a system previously unavailable using US (ultrasound) that is based on a common lexicon to categorize malignancy risk throughout the spectrum of benign and more suspicious lesions and provide guidelines for management,” the team wrote.

Going forward, they plan to validate O-RADS with results from the IOTA 5 study, the largest multicenter prospective study of patients with benign and malignant adnexal masses.