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. 2022 Nov;32(11):7854-7864.
doi: 10.1007/s00330-022-08803-6. Epub 2022 May 18.

Comparison of the O-RADS and ADNEX models regarding malignancy rate and validity in evaluating adnexal lesions

Guan-Yeu Chen  1   2 , Teh-Fu Hsu  3   4   5 , I-San Chan  1   2 , Chia-Hao Liu  1   2   5   6 , Wei-Ting Chao  1   2   5   6 , Ying-Chu Shih  1   2 , Ling-Yu Jiang  1   2   5   6 , Yen-Hou Chang  1   2   5   6 , Peng-Hui Wang  1   2   5   6   7   8 , Yi-Jen Chen  9   10   11   12
Affiliations

Comparison of the O-RADS and ADNEX models regarding malignancy rate and validity in evaluating adnexal lesions

Guan-Yeu Chen et al. Eur Radiol. 2022 Nov.

Abstract

Objective: This study aimed to compare the ability of the O-RADS and ADNEX models to classify benign or malignant adnexal lesions.

Methods: This retrospective single-center study included women who underwent surgery for adnexal lesions. Two gynecologists independently categorized the adnexal lesions according to the O-RADS and ADNEX models. Four additional readers were included to validate the new quick-access O-RADS flowchart.

Results: Among the 322 patients included in this study, 264 (82.0%) had a benign diagnosis, and 58 (18.0%) had a malignant diagnosis. The malignant rates of O-RADS 2, O-RADS 3, O-RADS 4, and O-RADS 5 were 0%, 3.0%, 37.7%, and 78.9%, respectively. The AUC of the O-RADS in the 322 patients was 0.93. On comparing the O-RADS and ADNEX models in the remaining 281 patients, the AUCs of the O-RADS, ADNEX model with CA125, and ADNEX model without CA125 were 0.92, 0.95, and 0.94, respectively. When setting a uniform cutoff of ≥ 10% (≥ O-RADS 4) to predict malignancy, the O-RADS had higher sensitivity than the ADNEX model (96.6% vs. 91.4%), and relatively similar specificity. In addition, the readers with the quick-access flowchart spent less time categorizing O-RADS than the readers with only the original O-RADS table (mean analysis time: 99 min 15 s vs. 111 min 55 s).

Conclusions: The O-RADS classification of the adnexal lesions as benign or malignant was comparable to that of the ADNEX model and had higher sensitivity at the 10% cutoff value. A quick-access O-RADS flowchart was helpful in O-RADS categorization and might shorten the analysis time.

Key points: • Both O-RADS and ADNEX models had good diagnostic performance in distinguishing adnexal malignancy, and O-RADS had higher sensitivity than ADNEX model in uniform 10% cutoff to predict malignancy. • Quick-access O-RADS flowchart was developed to help review O-RADS classification and might help reduce the analysis time.

Keywords: Adnexal diseases; ROC curve; Sensitivity and specificity; Ultrasonography.

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