Farname Inc. in collaboration with Iranian Society of Gynecology Oncology

Document Type : Letter to the Editor

Authors

1 Department of Radiology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran

2 Department of Radiology, Taleghani Hospital, Mazandaran University of Medical Sciences, Chalus, Iran

3 Department of Gynecologic Oncology, Yas Hospital, Tehran University of Medical Sciences, Tehran, Iran

Abstract

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).

Keywords

Main Subjects

Dear Editor in Chief
 


Adnexal masses characterization is a challenging issue and essential for appropriate patient management. Morphological scoring systems that combine important structural features of adnexal tumors are necessary to determine the risk of malignancy (2).
International Ovarian Tumor Analysis (IOTA) and Ovarian Adnexal Reporting and Data System (O-RADS) are two excellent standardized lexicons to provide practical uniform terms, definitions, and measurements for describing and classifying ovarian masses (1,5).
The O-RADS system has mostly used the evidence-based terms and definitions of the International Ovarian Tumor Analysis (IOTA) model (1, 2, 3). The maximum size of papillary projection/solid component is one of these features that has a nearly high positive likelihood ratio (LR) of malignancy (2.4). This item had a higher positive LR compared to other variables related to the size of the solid part as papillary/lesion ratio and solid/lesion ratio with positive LR of 1.6 and 1.5 respectively (2).
It had been included in both IOTA simple rules and Assessment of Different Neoplasia in the Adnexa (ADNEX) model. In the ADNEX model, when only the maximal diameter of the largest solid part is selected from <7mm to significantly higher than 7mm, the risk of malignancy can change from less than 10% to higher than 50% (O-RADS 3 to O-RADS 5). Furthermore, when we choose the maximal diameter of the largest solid part of ≥7 mm and change other items (except selecting acoustic shadow), the risk of malignancy is nearly always higher than 10%.
In the first publication of the O-RADS system, they noted that cystic lesions with a maximum diameter of the solid component of ≥7 mm, are at higher risk for malignancy (4). On the other hand, it had been shown that the number of papillary projections had nearly similar positive LR (2.2) (2). Despite this and the inclusion of the number of papillary projections in the final risk stratification system, the maximal size of the solid part was not included, and no cystic lesion with a solid component could be categorized in O-RADS 3 category. The size of the papillary projection makes no change in malignancy risk stratification. Adding this item and other criteria could improve the current classification and management system.


 

Conclusion

In conclusion, we propose that in the O-RADS lexicon, the use of maximal diameter of solid components (with a 7 mm cut-off point) along with some papillary projections is helpful to categorize cystic ovarian mass lesions as an auxiliary item for classifying the risk of malignancy less than 10% to higher than 50% (O-RADS 3 to ORADS 5).

 

Acknowledgments

 

None.

 

Conflicts of Interest

The authors declare no conflicts of interest.
 

 
1. Timmerman D, Testa AC, Bourne T, Ameye L, Jurkovic D, Van Holsbeke C, et al. Simple ultrasound‐based rules for the diagnosis of ovarian cancer. Ultrasound Obstet Gynecol. 2008;31(6):681-90. [DOI:10.1002/uog.5365] [PMID]
2. Andreotti R, Timmerman D, Benacerraf B, Bennett G, Bourne T, Brown D, et al. Ovarian-adnexal reporting lexicon for ultrasound: a white paper of the ACR Ovarian-Adnexal Reporting and Data System Committee. J Am Coll Radiol. 2018;15(10):1415-29. [DOI:10.1016/j.jacr.2018.07.004] [PMID]
3. Timmerman D, Valentin L, Bourne TH, Collins WP, Verrelst H, Vergote I. Terms, definitions and measurements to describe the sonographic features of adnexal tumors: a consensus opinion from the International Ovarian Tumor Analysis (IOTA) Group. Ultrasound Obstet Gynecol. 2000;16(5):500-5. [DOI:10.1046/j.1469-0705.2000.00287.x] [PMID]
4. Andreotti RF, Timmerman D, Strachowski LM, Froyman W, Benacerraf BR, Bennett GL, et al. O-RADS US risk stratification and management system: a consensus guideline from the ACR Ovarian-Adnexal Reporting and Data System Committee. Radiology. 2020;294(1):168-85. [DOI:10.1148/radiol.2019191150] [PMID]
5. Timmerman D, Van Calster B, Testa A, Savelli L, Fischerova D, Froyman W, et al. Predicting the risk of malignancy in adnexal masses based on the Simple Rules from the International Ovarian Tumor Analysis group. Am J Obstet Gynecol. 2016;214(4):424-37. [DOI:10.1016/j.ajog.2016.01.007] [PMID]