From the Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, H1307, Stanford, CA 94305 (L.S., A.K., N.A., P.J.); Departments of Radiology (E.A.S.) and Obstetrics and Gynecology (E.A.S., L.M.B.), University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Imaging Sciences, University of Rochester, Rochester, NY (A.G.); Department of Radiology and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (K.K.P.L.); Department of Radiology, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pa (H.M.Z.); and Department of Radiology, Brigham and Women's Hospital, Boston, Mass (Y.G.).
Radiology. 2024 Oct;313(1):e240044. doi: 10.1148/radiol.240044.
Background The Ovarian-Adnexal Imaging Reporting and Data System (O-RADS) US risk score can be used to accurately stratify ovarian lesions based on morphologic characteristics. However, there are no large multicenter studies assessing the potential impact of using O-RADS US version 2022 risk score in patients referred for surgery for an ovarian or adnexal lesion. Purpose To retrospectively determine the proportion of patients with ovarian or adnexal lesions without acute symptoms who may have been managed conservatively by using the O-RADS US version 2022 risk score. Materials and Methods This multicenter retrospective study included patients with ovarian cystic lesions and nonacute symptoms who underwent surgical resection after US before the introduction of O-RADS US between January 2011 and December 2014. Investigators blinded to the final diagnoses recorded lesion imaging features and O-RADS US risk scores. The frequency of malignancy and the diagnostic performance of the risk score were calculated. The Mann-Whitney test and Fisher exact test were performed, with < .05 indicating a statistically significant difference. Results A total of 377 patients with surgically resected lesions were included. Among the resected lesions, 42% (157 of 377) were assigned an O-RADS US risk score of 2. Of the O-RADS US 2 lesions, 54% (86 of 157) were nonneoplastic, 45% (70 of 157) were dermoids or other benign tumors, and less than 1% (one of 157) were malignant. Using O-RADS US 4 as the optimal threshold for malignancy prediction yielded a 94% (68 of 72) sensitivity, 64% (195 of 305) specificity, 38% (68 of 178) positive predictive value, and 98% (195 of 199) negative predictive value. Conclusion In patients without acute symptoms who underwent surgery for ovarian and adnexal lesions before the O-RADS US risk score was published, nearly half (42%) of surgically resected lesions retrospectively met the O-RADS US 2 version 2022 criteria. In these patients, imaging follow-up or conservative management could have been offered. © RSNA, 2024 See also the editorial by Fournier in this issue.
卵巢-附件成像报告和数据系统（O-RADS）美国风险评分可用于根据形态特征准确分层卵巢病变。然而，尚无大型多中心研究评估在因卵巢或附件病变就诊并接受手术的患者中使用 2022 年 O-RADS US 版风险评分的潜在影响。目的：回顾性确定无急性症状的卵巢或附件病变患者中，使用 O-RADS US 2022 版风险评分可能进行保守治疗的比例。材料与方法：本多中心回顾性研究纳入了 2011 年 1 月至 2014 年 12 月在 O-RADS US 推出前接受 US 引导下手术切除的卵巢囊性病变且无急性症状的患者。研究人员对最终诊断不知情，记录了病变的影像学特征和 O-RADS US 风险评分。计算了恶性肿瘤的频率和风险评分的诊断性能。采用 Mann-Whitney 检验和 Fisher 确切概率检验， <.05 表示差异有统计学意义。结果：共纳入 377 例接受手术切除病变的患者。在切除的病变中，42%（157/377）的病变 O-RADS US 风险评分为 2 分。在 O-RADS US 2 分病变中，54%（86/157）为非肿瘤性病变，45%（70/157）为皮样囊肿或其他良性肿瘤，< 1%（1/157）为恶性肿瘤。将 O-RADS US 4 作为恶性肿瘤预测的最佳阈值，其灵敏度为 94%（68/72），特异度为 64%（195/305），阳性预测值为 38%（68/178），阴性预测值为 98%（195/199）。结论：在 O-RADS US 风险评分发布前因卵巢和附件病变就诊并接受手术的患者中，近一半（42%）的手术切除病变回顾性符合 O-RADS US 2 版 2022 标准。在这些患者中，可以提供影像学随访或保守治疗。 © 2024 RSNA，见本期 Fournier 社论。
