Evaluation of American College of Radiology Ovarian‐Adnexal Reporting and Data System ultrasound to predict malignancy risk in adnexal lesions

To validate the diagnostic performance of Ovarian-Adnexal Reporting and Data System (O-RADS) ultrasound for preoperative adnexal lesions in an external center. The secondary aim was to evaluate the performance of a strategy test including O-RADS ultrasound evaluation and subjective assessment of higher malignant risk lesions.One hundred thirty patients with 158 ovarian-adnexal lesions were enrolled in the study. Each lesion was assigned an O-RADS score after real-time ultrasound examination by one experienced radiologist. A second subjective assessment by an expert was performed for O-RADS 4 and O-RADS 5 lesions. The histopathological diagnosis was used as the reference standard.A total of 126 benign and 32 malignant adnexal masses were included in the study. The area under the receiver operating characteristic curve of O-RADS ultrasound was 0.950, with a cutoff value > O-RADS 3. The sensitivity, specificity, and negative and positive predictive values were 100% (95% confidence interval [CI], 0.867-1), 83.3% (95% CI, 0.754-0.892), 60.4% (95% CI, 0.460-0.732), and 100% (95% CI, 0.956-1), respectively. For the strategy test, the sensitivity, specificity, negative and positive predictive values were 100% (95% CI, 0.867-1), 92.1% (95% CI, 0.855-0.959), 76.2% (95% CI, 0.602-0.874), and 100% (95% CI, 0.960-1), respectively. In comparison with O-RADS ultrasound, the specificity and negative predictive value of the strategy test were slightly higher (p < 0.05).Good diagnostic performance of the O-RADS ultrasound in adnexal lesions can be achieved by experienced radiologists in clinical practice. A second subjective assessment of sonographic findings can be applied to O-RADS 4 and 5 lesions.