O-RADS

O-RADS™” is an acronym for an Ovarian-Adnexal Imaging-Reporting-Data System which will function as a quality assurance tool for the standardized description of ovarian/adnexal pathology. The creation of a standardized lexicon permits the development of a practical, uniform vocabulary for describing the imaging characteristics of ovarian masses that can be used to determine malignancy risk, with the ultimate goal of applying it to a risk stratification classification for consistent follow up and management in clinical practice.

The use of internationally agreed upon standardized descriptors should result in consistent interpretations and decrease or eliminate ambiguity in reports resulting in a higher probability of a correct diagnosis. In the case of the adnexal mass, the correct interpretation leading to the correct diagnosis is the key to accuracy in determining risk of malignancy and, finally, optimal patient management.

In the Summer of 2015, under the supervision of the American college of Radiology, the Ovarian-Adnexal Reporting and Data System(O-RADS) Committee was formed with the purpose of creating a standardized lexicon for describing the imaging characteristics of ovarian and adnexal masses and applying it to a risk stratification and management system for evaluation of malignancy. This is an ongoing collaborative effort of an international group of experts in gynecological imaging and management of ovarian/adnexal masses that includes a broad spectrum of experts in radiology, gynecology, pathology, and gynecologic oncology from the US, Canada, Europe, and the United Kingdom.

Since ultrasound is widely considered the primary imaging modality in the evaluation of adnexal masses and MRI the problem-solving tool, parallel working groups (US and MRI) were formed to develop separate but consistent groups of terms specific to each modality. The principal goals of O-RADS are to improve the quality and communication between interpreting and referring physicians, to limit variability in reporting language and ultimately to guide patient management based on actionable information in the imaging report. The committee is sponsored by the American College of Radiology with eventual lexicon trademark by the aforesaid organization.

O-RADS Benign Descriptors Table

O-RADS Ultrasound Lexicon Paper  

O-RADS Lexicon Key Terms Table

O-RADS US Risk Stratification Paper 

O-RADS Risk Stratification System Table

Training and Educational Resources

• Training
 
• Templates

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O-RADS Ultrasound Lexicon Training Module

ABUS deliveres better diagnostic performance

By Wayne Forrest, AuntMinnie.com staff writer

December 9, 2019 -- Both automated breast ultrasound (ABUS) and traditional handheld ultrasound can significantly improve breast cancer detection when used as an adjunct to mammography in women with dense breasts. But ABUS yields better diagnostic performance, according to research presented at RSNA 2019 in Chicago.

In a study involving over 1,200 women, a team of researchers led by Dr. Mengmeng Jia of the Chinese Academy of Medical Sciences in Beijing found that ABUS produced a higher specificity, positive predictive value, and area under the curve (AUC) than handheld ultrasound.

Breast cancer is the most commonly diagnosed cancer in Chinese women, but less than 1% of cases are detected by screening, according to Jia. Compared with Western countries, Chinese women also have a higher proportion of dense breasts, for which mammography is less sensitive, she said. As a result, these patients need adjunctive imaging modalities such as ultrasound, digital breast tomosynthesis, or MRI.

Traditional handheld ultrasound is inexpensive, safe, and suitable for dense breasts. But it's also labor intensive and highly dependent on the operator. ABUS, on the other hand, is specifically designed for finding cancer in dense breast tissue. It's also reproducible due to its operator-independent acquisition method, Jia noted.

"Most importantly, the image acquisition can be separated from interpretation," she said. "That means that images can be taken by the operator and then interpreted by radiologists [at another location]. That is helpful in resource-limited areas [where there are not enough qualified radiologists]."

The researchers sought to evaluate the diagnostic performance of ABUS and handheld ultrasound as an adjunct to mammography in women ages 40 to 69. They also wanted to assess the performance of both methods in mammography-negative dense breasts.

The team enrolled 1,266 women ages 40 to 69 in a multicenter study involving five tertiary hospitals. All women received mammography, as well as handheld ultrasound and ABUS. Of the 1,266 women, 958 were deemed to have dense breasts.

Overall, sensitivity increased from 87.3% with mammography alone to 96.9% for both handheld ultrasound and ABUS. Negative predictive value also increased from 95.5% to 98.8% with handheld ultrasound and 98.8% for ABUS. Mammography alone had an AUC of 0.88, compared with an AUC of 0.92 for mammography and handheld ultrasound and 0.93 for mammography and ABUS.

In women with mammographically negative dense breasts, ABUS and handheld ultrasound detected 31 additional cases of breast cancer. The techniques had comparable sensitivity and negative predictive value, but ABUS had a higher specificity, positive predictive value, and AUC, according to the researchers.

Performance in women with mammographically negative dense breasts
	Handheld ultrasound	ABUS
Sensitivity	31/33 (93.9%)	31/33 (93.9%)
Specificity	619/665 (93.1%)	635/665 (95.5%)
Positive predictive value	31/77 (40.3%)	31/61 (50.8%)
Negative predictive value	619/621 (98.8%)	635/637 (99.7%)
Area under the curve	0.935	0.947

"More studies are [now] needed to [further] evaluate the performance of adjunctive ultrasonography, including ABUS and handheld ultrasound,  in [resource]-limited areas," Jia concluded.