Can lesions in high risk and symptomatic patients be included in any part of the O-RADS system?
Does O-RADS apply to all ovarian and adnexal lesions?
How do you manage the stable O-RADS 3 or 4 lesion?
When is a study considered O-RADS 0, an “incomplete evaluation”?
Can we risk stratify a changing endometrioma or dermoid?
Who is the ultrasound specialist?



FAQ-181: Can lesions in high risk and symptomatic patients be included in any part of the O-RADS system?


The lexicon and O-RADS categories can be applied to any lesion; however, use of the management aspect is restricted to patients of average risk. The following is the specific governing concept for our risk management system that applies to this question and can be found in the published article and on the ACR website:


“The management system is based upon an average risk patient with no acute symptoms and no substantial risk factors for ovarian cancer such as a significant family history of ovarian cancer or BRCA gene mutation. If these factors are present, management may vary from this system.”


We specifically refer to the variation in management for these patients but do not discourage the use of lexicon descriptors to risk stratify the individual lesions. The IOTA literature and IOTA 1-3 data, upon which the system is based, consists of consecutive patients with no cited exclusions. Lesions in high as well as average risk patients were included. Ergo, it is acceptable to risk stratify any lesion using descriptors or the ADNEX model. We are scoring the appearance of the lesion, not giving a general risk of malignancy to the patient based upon other criteria. However, since other patient issues must be addressed, the management of a patient with acute symptoms or who is at high risk will likely vary from the recommended scheme. 



Did you find FAQ-181 helpful?     Yes     No 




FAQ-182: Does O-RADS apply to all ovarian and adnexal lesions?

  

The following is the specific governing concept for our risk management system that applies to this question and can be found in the published article and on the ACR website:


O-RADS applies only to lesions involving the ovaries and/or fallopian tube. If a pelvic lesion origin is indeterminate but suspected to be ovarian or fallopian in origin, the O-RADS system may apply. If a pelvic lesion is clearly identified as non-ovarian/tubal in origin then the O-RADS system would be appropriate only in the case of a paraovarian cyst or peritoneal inclusion cyst and, otherwise, does not apply.  


Did you find FAQ-182 helpful?     Yes     No 




FAQ-183: How do you manage the stable O-RADS 3 or 4 lesion? 

  

If a study demonstrates stability of an O-RADS 3 or 4 lesion (low risk or moderate risk), according to management recommendations, further characterization by an US specialist, that may include the use of the IOTA/ADNEX Model, or referral for an MRI study should be suggested if this has not already been performed. The ultimate management decision of whether to proceed with surgery or continue surveillance would be made by the managing Gynecologist or Gyn-Oncologist.

   

 Did you find FAQ-183 helpful?     Yes     No 




FAQ-184: When is a study considered O-RADS 0, an “incomplete evaluation”? 


O-RADS 0 covers the situation of a technically inadequate or incomplete study. This may occur when a patient declines a transvaginal evaluation, requests to discontinue a study on the basis of discomfort or technical factors such as bowel gas artifact obscuring a lesion. In these cases, a judgement is made as to whether repeating the ultrasound study will add value or whether an MRI should be considered for exam completion.  Please note this applies to an incomplete study from a technical perspective, rather than to an indeterminate or non-diagnostic study from an interpretative perspective.


Did you find FAQ-184 helpful?     Yes     No 




FAQ-185: Can we risk stratify a changing endometrioma or dermoid? 


According to the O-RADS US system an endometrioma or dermoid < 10 cm with changing morphology or developing vascular component on follow up would have a suspicious component and is no longer a “classic benign lesion” in the O-RADS 2 category but additional O-RADS scoring is not advisable. The management recommendation is referral to an US specialist or for an MRI study for further characterization. 


Did you find FAQ-185 helpful?     Yes     No 




FAQ-186: Who is an ultrasound specialist?


The following is the specific governing concept for our risk management system that applies to this question and can be found in the published article and on the ACR website:


The involvement of an “ultrasound specialist,” denoted as a physician whose practice includes a focus on ultrasound assessment of adnexal lesions has been added to the O-RADS US System. However, at this time, there are no mandated requirements or guidelines that define such a specialist. 

This is the person at your institution or within your referral patterns who would be asked for a second opinion when the imager is faced with a challenging ovarian/adnexal lesion. Radiologists who are ultrasound specialists would usually have fellowship training that would include pelvic ultrasound. There is evidence that experts demonstrate high accuracy in evaluation of malignancy, so it is prudent to make use of available expertise rather than refer the patient for an M


Did you find FAQ-186 helpful?     Yes     No