Adnexal masses characterization is a really challenging issue and is essential for appropriate patient management. Ovarian Adnexal Reporting and Data System (O-RADS) is tone excellent standardized lexicons to provide practical uniform terms, definitions and measurements for describing and classifying ovarian masses.
In the first publication of O-RADS system, they noted that cystic lesions with maximum diameter of solid component of ≥7 mm, are at higher risk for malignancy. On the other hand, the number of papillary projections had nearly similar positive LR (2.2). Despite this and inclusion of the number of papillary projections in the final risk stratification system, the maximal size of solid part was not included and no cystic lesion with solid component could be categorized in O-RADS 3 category, and size of papillary projection make no change in malignancy risk stratification.
In conclusion, we propose that in O-RADS lexicon the use of maximal diameter of solid components (with 7 mm cut off point) along with number of papillary projections is helpful to categorize cystic ovarian mass lesions as auxiliary item for classifying risk of malignancy less than 10% to higher than 50% (O-RADS 3 to ORADS 5).