- •The ACR O-RADS US has a good diagnostic performance in differentiating malignant from benign adnexal lesions.
- •The ACR O-RADS US is applicable to radiologists with different experience even freshman.
- •Explicit sub-classification into two groups among O-RADS 4 lesions showed better stratification of the intermediate risk.
To assess the diagnostic performance and inter-observer agreement of the American College of Radiology (ACR) Ovarian-Adnexal Reporting and Data System Ultrasound (O-RADS US).
From January 2016 to December 2018 a total of 1054 adnexal lesions in 1035 patients with pathologic results from two hospitals were retrospectively included. Each lesion was assigned to an O-RADS US category according to the criteria. Kappa (κ) statistics were applied to assess inter-observer agreement between a less experienced and an expert radiologist.
Of the 1054 adnexal lesions, 750 were benign and 304 were malignant. The malignancy rates of O-RADS 5, O-RADS 4, O-RADS 3, and O-RADS 2 lesions were 89.57%, 34.46%, 1.10%, and 0.45% respectively. Area under the receiver operating characteristic curve was 0.960 (95% CI, 0.947–0.971). The optimal cutoff value for predicting malignancy was >O-RADS 3 with a sensitivity and specificity of 98.7% (95% CI, 0.964–0.996) and 83.2% (95% CI, 0.802–0.858) respectively. When sub-classifying multilocular cysts and smooth solid lesions in O-RADS 4 lesions as O-RADS 4a lesions and the rest cystic lesions with solid components as O-RADS 4b lesions, the malignancy rate were 17.02% and 42.57% respectively, which showed better risk stratification (P < 0.001). The inter-observer agreement between a less-experienced and an expert radiologist of O-RADS categorization was good (κ = 0.714).
The ACR O-RADS US provides effective malignancy risk stratification for adnexal lesions with high reliability for radiologists with different experience. Sub-grouping of O-RADS 4 lesions into two groups facilitated better stratification of the intermediate risk.
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Published online: May 06, 2021
Accepted: April 24, 2021
Received: February 19, 2021
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