Highlights
- •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.
Abstract
Objective
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).
Methods
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.
Results
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).
Conclusions
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.
Keywords
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Article info
Publication history
Published online: May 06, 2021
Accepted:
April 24,
2021
Received:
February 19,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
