Orads

Ovarian Reporting and Data System

1. O RADS

2. O- RADS

3. Size

Maximum Maximum diameter of a lesion in any plane
diameter
Solid or Solid-Appearing Lesions

External contour
Smooth Regular outer margin
Irregular (Not Non-uniform outer margin Alobulated outer margin is considered
Smooth) irregular

Internal contents
Acoustic Artifact produced by attenuated echoes behind a Descriptor is commonly associated with
shadowing sound absorbing structure calcification(s) or fibromatous type lesion

ic Lesions.
Inner Margin or Walls Including Solid Component
Papillary Solid component whose height > 3 mm, arises from | Number of papillary projections should |
projection or the cyst wall or septation and protrudes into the cyst | be included
nodule cavity
Smooth Regular, uniform inner margin that may include inner
margin of a solid component that is not a papillary
projection

Trregular (not Irregular, non-uniform inner margin. May include wall
smooth) irregularities due to incomplete septations, solid

components < 3mm height, papillary projections, the
contour of the solid component or the margin of any
internal cystic area within the solid component

4. Internal Content, Cystic Component

| Anechoic fluid | No intemal echoes or structures of any kind
Hyperechoic ‘Area of increased echogenicity with respect to normal | Descriptor associated with dermoid cysts
components ‘ovarian parenchyma without acoustic shadowing ‘or hemorrhagic lesions

“Classic” Benign Descriptors- See Figure 3 definitions

© Hemorrhagic cyst
© Dermoid cyst
© Endometrioma

Vascularity

Color score 1-4

‘Overall subjective assessment of color Doppler flow
within the entire lesion (wall and/or internal
component)

Color Score
No flow

Color Score = 2
Minimal Flow

Color Score = 3
Moderate flow

Color Score = 4
Very Strong Flow

TOTA Group criteria using vendor
recommended settings

Spectral Doppler may be needed to
distinguish vascular flow from artifact

5. General and ua Findings

“Classic® Benign Descriptors- See Figure 3 definitions
o Paraovarian cyst
© Peritoneal inclusion cyst
< Fallopian tube (fluid distended)

Fluid Cul-de-sac fluid | Confined to pouch of Douglas as defined by remaining
Descriptors below uterine fundus or between uterus and bladder
when uterus retrovertediretroflexed

Ascites Fluid extending above uterine fundus beyond the
pouch of Douglas or cul-de-sac when
anteverted/anteflexed, and anterior/superior to uterus
when retroverted/retroflexed

Other Peritoneal Nodularity or diffuse thickening of the peritoneal
thickening or lining(s) or along the bowel serosal surface or
nodules peritoneum associated with peritoneal carcinomatosis

6. O-RADS US Risk Stratification and Management System

Management

O-RADS | Risk Category or
Score [IOTA Model] acc Decio Pre- Post-
menopausal _| menopausal
9 Incomplete
NA Repeat study or alternate study
7 Normal Ovary | Folicie defined as a simple cyst 23 om N in
메시 Corpus Luteum < 3cm one
sam NA None
Simple cyst > Semto Som tere Follow up in
iowupin | Svea
> <4 year.
5 cm but < 10 0m epa

‘Classic Benign Lesions

See Figure 3 for management

See Figure 3 for separate descriptors ‘strategies
Follow up in
1 year*
s3cm None If conceming, US
Non-simple unilocular specialist or MRI
cyst, smooth inner Follow-up in
margin

> 3 cm but < 10cm

8-12weeks | US specialist
Ifconceming, | or MRI

Multilocular cyst < 10 cm, smooth inner wall, CS = 1-3

US specialist
Tow Risk Unilocular cyst = 10 cm (simple or nonrsimple)
Malignancy
o Typical dermoid cysts, endometriomas, hemorrhagic cysts = 10 cm een
Uniocular cyst, any size with regular inner wall <3 mm height Management by gynecologist

Solid smooth, any size, CS = 1

7. LowRisk | Unilocular cyst 10 cm (simple or non-simple)
Melon” | Typical dermoid cysts, endometriomas, hemorrhagic ysts s 10 cm
Unilocular cyst, any size with irregular inner wall <3 mm height

Multiocular cyst < 10 em, smooth inner wall, CS = 1-3

‘Solid smooth, any size, CS = 1

US specialist or MRI
Management by gynecologist

Intermediate Risk = 10 cm, smooth inner wall, CS = 1-3
Multilocular cyst, Any size, smooth inner wall, CS = 4

A ‘Any size, irregular inner wall and/or irregular septation, any color
score

US specialist or MRI

Management by gynecologist with
GYN-oncologist consultation or
solely by GYN-oncologist

Any size, 0-3 papillary projections, CS = any

Any size, CS = 1-2

Smooth, any size, CS = 2-3

e Unilocular cyst, any size, 2 4 papillary projections, CS = any
Multilocular cyst with solid component, any size, CS = 3-4
Solid smooth, any size, CS = 4 GYN-oncologist
Solid irregular, any size, CS = any
Ascites and/or peritoneal nodules

8. Suggested Management ‘Suggested Management

criba] — Premenopausal ‘Postmenopausal
Ratclarpatem: Fine tin intrsecing | $56 US 00001. gynecologist or
Typical lines representing fn strands None MR
Pemonhe | racing co: An vasc 35 em but io em
se Seen conponet serlo, | Foowup 0-7 vents US speci geal or
Straight, orconcave margins | lf persists or enlarges, referalto US | MRI
specialist, gynecologist, or MRI
+ Hyperechoic component with en an u
acruscshaowing tional inital flow up in 8-12 weeks
‘Typical dermoid 。 : Hyporechoic Ines and dots based upon confidence in diagnosis | yp, a
eyst< 100m + Floating echogenic spherical cent agro. rot
‘structures: It not removed surgically, annual US = TO
folow up hou then be considered = | OO up shoud
Typical US special or MRI ther is
{Ground glass/homogeneous low-level,
sgrdometrioma | echoes enlargement changing morphalogy ora | Monge masa e
Pope tela corporat developing vascular component
00
Le rary wen pressure à : ‘year
= the transducer atea
Folows me concur ofthe adjacent
Peine organ or pertoneum dors not
pial portones! | Ma nase loc and pooly
reunion cystany | contains septaions. The ovary is CEE Gynecologist
‘her at he margin or suspended
ti the lesion
incompleto septation
Typical ‘Tubular
hyarosalpina/any | Endosaipngea! ts: Shortround 。 | Gynecologist meca
sis ORectone around he nner wal of
id intended tubular suche.

Figure 3: | image shows Ovoron-AdhealReporieg and Dato Sym (0-#AD5) US sk con and monagament ae fo cnse benign sons and amociomd

desc [O-RADS 2} * = Tire acne pauciy of evidence by deiing optimal hrason o nero ol tring lr weiowce Ederce does sport on nceasng

‘ko makgrarey n endometionasiloweg manspavse, ん doc wth parisien kom ho Amatcan Colega Rod.

9. IOTA Phase 1-3 Data Used to Define O-RADS Categories

Description Fulfill Criterion Malignant
7 1452 24.0) 705
Classic hemorthagic eyst 5 cm to <10 em 11 (0.2) 00)
Classic dermoid cyst <10 em 32154) 00)
Classic endometrioma <10 cm 583 (9.9) 40.7)
Unilocular smooth cyst =3 em 5409) 00)
Other unilocular smooth cyst >3 cm to <10 cm 483 (8.2) 30.6)
19% to <10% 945 (16.0) 34 (3.6)
Unilocular smooth 2:10 em 185 3.0) 5022)
Unilocular irregular wall 101 (1.7) 4(4.0)
Mulrilocular smooth CS 1-3 <10 em 577 (9.8) 19 33)
Solid smooth CS 1 82 (14) 603)
10% to <50% 1734 (29.3) 516 (29.8)
Multilocular smooth =10 cm CS 1-3 227 (38) 4118.)
Multilocular smooth CS 4 204) 313.6)
Multilocular irregular 182 (3.1) 35 (19.2)
Unilocular-sol 198 (3.4) 58 (29.3)
Unilocular-solid 1-3 papillary projections 338 (5.7) 98 (29.0)
Mukilocular-solid CS 1-2 405 (6.9) 126 (31.1)
Solid smooth CS 2-3 362 (6.1) 155 (42.8)

50%-100% 1774 (30.0) 1374 (77.5)
Unilocular-solid with =4 papillary projections 94 (1.6) 64 (68.1)
Muilocular-solid CS 3-4 619 (10.5) 372 (60.1)
Solid smooth CS 4 135 2.3) 104 (77.0)
Solid irregular 206 (3.5) 178 (86.4)
Ascites or metastases 720 (12.2) 656 (91.1)

Note.—Data are the number of lesions that fulfill cach criteria, with percentages in parentheses.
Source —References 14, 15. CS = color score, IOTA = International Ovarian Tumor Analysis, O-
RADS = Ovarian-Adnexal Reporting and Data System.

10. O-RADS 1 - Normal Ovary (0% likelihood of malignancy)*

Follicle

Unilocular, anechoic cyst,
<3cm

Corpus Luteum
Thick-walled cyst < 3 cm +
crenulated inner margin,
internal echoes, peripheral
flow

OR

Hypoechoic region with
peripheral flow but without
characteristic cystic
component

Figure 6 Image shows Ovarion-Adnexel Reporting a

11. O-RADS Almost Certainly Benign (<1% likelihood of malignancy)

Simple Cyst
> 3 -<10 em in premenopausal women
< 10 cm In postmenopausal women

Classic Benign Lesions “O-RADS 2 - Classic Benign Lesions
and Associated Descriptors”

~

Non-simple*, unilocular cyst with
smooth inner margin, < 10 cm

* “Non-simple" applies when internal echoes or
incomplete septa are present. Note, an incomplete
septum Is not considered wall irregularity ifthe
inner margin is otherwise smooth.

12. Typical
Hemorrhagic
Cyst, < 10 cm

Typical Dermoid
Cyst, < 10 cm

Typical
Endometrioma,
<10cm

13. Simple
Paraovarian
Cyst (any size)

Typical
Peritoneal

Inclusion Cyst
(any size)

Typical
Hydrosalpinx
(any size)

Figure 9: Imog ( Adnexal Reporting ond Dato System [O-RAD! legoy 2 id

14. O-RADS 3 - Low Risk (1 - < 10% likelihood of malignancy)

Unilocular cyst*, 2 10 cm

Simple or non-simple

Typical hemorrhagic eyst, dermoid
cyst, endometrioma, > 10 cm

y A
ES
See Figure 9:

“O-RADS 2 - Classic Benign Lesions
and Associated Descriptors”

Unilocular cyst with irregular inner
wall”, any size

23 mm height

Multilocular cyst with smooth inner
wall, < 10 cm, color score 1-3"

"Color score 1-3: No to moderate flow

Solid or solid-appearing (2 80%)
with smooth contour, any size,
color score 1”

“Color score 4: No flow

Figure 13: Imago shows Ovaran An

15. O-RADS 4 - Intermediate Risk (10 - < 50% likelihood of malignancy)

Multilocular cyst with smooth inner
wall, 210 cm, color score 1-3*

Color score 13: No to moderate flow

'Unilocular cyst with 1-3 papillary
projections, any size, any color score

Multilocular cyst with smooth inner
wall, any size, color score 4*

Color score 4: Very strong flow

Muitilocular cyst with solid/solid-
appearing component, any size,
color score 1-2*

“Color score 1-2: No to mil ow

Multilocular cyst with irregular inner
wall and/or irregular septation,
any size, any color score

Unllocular cyst with solidsolid
appearing component, no papillary
projections, any size, any color score

‘Solid (2 80%) with smooth contour,
any size, color score 2.3

"Color scone 23: Mil to moderate flow

16. High Risk (2 50

Unilocular cyst with 2 4 papillary
projections, any size, any color score

Muitilocular cyst with solid component,
any size, color score 3-4*

ca

score 3-4: Moderate to very strong flow

‘Solid (2 80%) with smooth contour,
any size, color score 4%

score 4: Very strong now

Solid or solid-appearing (2 80%)
with irregular contour, any size,
any color score

Ascites and/or peritoneal nodules

Figure 15: image shows Ou epost: