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O-RADS MRI score: analysis of misclassified cases in a prospective multicentric European cohort

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Abstract

Objective

To retrospectively review the causes of categorization errors using O-RADS-MRI score and to determine the presumptive causes of these misclassifications.

Methods

EURAD database was retrospectively queried to identify misclassified lesions. In this cohort, 1194 evaluable patients with 1502 pelvic masses (277 malignant / 1225 benign lesions) underwent standardized MRI to characterize adnexal masses with histology or 2 years’ follow-up as a reference standard. An expert radiologist reviewed cases with two junior radiologists and lesions termed misclassified if malignant lesion was scored ≤ 3, a benign lesion was scored ≥ 4, the site of origin was incorrect, or a non-adnexal mass was incorrectly categorized as benign or malignant.

Results

There were 139 / 1502 (9.2%) misclassified masses in 116 women including 109 adnexal and 30 non-adnexal masses. False-negative cases corresponded to 16 borderline or invasive malignant adnexal masses rated score ≤ 3 (16 / 139, 11.5%). False-positive cases corresponded to 88 benign masses were rated score 4 (67 / 139, 48.2%) or 5 (18 / 139,12.9%) or considered suspicious non-adnexal lesions (3 / 139, 2.2%). Misclassifications were only due to origin error in 12 adnexal masses (8 benign, 4 malignant) (8.6%, 12 / 139) and 23 non-adnexal masses (18 benign, 5 malignant,16.5%, 23 / 139) perceived respectively as non-adnexal and adnexal masses. Interpretive error (n = 104), failure to recognize technical insufficient exams (n = 9), and perceptual errors (n = 4) were found. Most interpretive was due to misinterpretation of solid tissue or incorrect assignment of mass origin. Eighty-four out of 139 cases were correctly reclassified by the readers with strict adherence to the score rules.

Conclusion

Most errors were due to misinterpretation of solid tissue or incorrect assignment of mass origin.

Key Points

• Prospective assignment of O-RADS-MRI score resulted in misclassification of 9.25% of sonographically indeterminate pelvic masses.

• Most errors were interpretive (74.8%) due to misinterpretation of solid tissue as defined by the lexicon or incorrect assignment of mass origin.

• Pelvic inflammatory disease is a common source of misclassification (8.9%) (12 / 139).

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Abbreviations

ACR:

American College of Radiology

ADNEX-MR score:

ADNEXal Magnetic Resonance score

CCTIRS:

Comité Consultatif sur le Traitement de l'Information en matière de Recherche dans le domaine de la Santé

DCE:

Dynamic contrast enhanced

DW:

Diffusion weighted

EURAD:

EURopean ADnexal

MRI:

Magnetic resonance imaging

O-RADS:

Ovarian Adnexal Reporting Data System

PID:

Pelvic inflammatory disease

SIFEM:

Société d’Imagerie de la Femme

STD:

Standard deviation

TIC:

Time-intensity curve

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Acknowledgements

EURAD Study group: I. Thomassin-Naggara, MD, PhD; E. Poncelet, MD; A. Jalaguier-Coudray, MD; A. Guerra, MD; L. S. Fournier, MD, PhD; S. Stojanovic, MD, PhD; I. Millet, MD, PhD; N. Bharwani, FRCR; V. Juhan, MD; T. M. Cunha, MD; G. Masselli, MD, PhD; C. Balleyguier, MD, PhD; C. Malhaire, MD; N. Perrot, MD; M. Bazot, MD; P. Taourel, MD, PhD, MSC; E. Darai, MD, PhD; and A. G. Rockall, MRCP, FRCR. Andrea Rockall acknowledges the support of the National Institute of Health Research Imperial Biomedical Centre and the Imperial Cancer Research UK Centre.

Funding

Isabelle Thomassin-Naggara received a grant from the Société d’imagerie de la femme.

Author information

Authors and Affiliations

  1. APHP, Sorbonne Université, Hôpital Tenon, Service de radiologie, 58 avenue Gambetta, 75020, Paris, France

    I. Thomassin-Naggara, M. Belghitti, A. Milon & C. Abdel Wahab

  2. Institut Universitaire de Cancérologie, Sorbonne Université, Hôpital Tenon, Service de radiologie, 75020, Paris, France

    I. Thomassin-Naggara, M. Belghitti, A. Milon & C. Abdel Wahab

  3. Departments of Radiology, Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372, Madison, WI, 53792-3252, USA

    E. Sadowski

  4. Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK

    A. G. Rockall

  5. Department of Radiology, Imperial College Healthcare NHS Trust, London, UK

    A. G. Rockall

Authors
  1. I. Thomassin-Naggara
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  2. M. Belghitti
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  3. A. Milon
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  4. C. Abdel Wahab
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  5. E. Sadowski
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  6. A. G. Rockall
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Consortia

on behalf of EURAD study group

  • I. Thomassin-Naggara
  • , E. Poncelet
  • , A. Jalaguier-Coudray
  • , A. Guerra
  • , L. S. Fournier
  • , S. Stojanovic
  • , I. Millet
  • , N. Bharwani
  • , V. Juhan
  • , T. M. Cunha
  • , G. Masselli
  • , C. Balleyguier
  • , C. Malhaire
  • , N. Perrot
  • , M. Bazot
  • , P. Taourel
  • , E. Darai
  •  & A. G. Rockall

Corresponding author

Correspondence to I. Thomassin-Naggara.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Isabelle Thomassin-Naggara.

Conflict of interest

Myriam Belghitti, Audrey Milon, Cendos Abdel Wahab, Elizabeth Sadowski, Andrea Rockall : no relationships with any companies whose products or services may be related to the subject matter of the article.

Isabelle Thomassin - Naggara: Receipt of honoraria or consultation fees (not related with the subject) with GE, Hologic, Canon, Guerbet, and one participation to board expert meeting (siemens).

Statistics and biometry

No statistical advice was asked for this manuscript. Statistics was performed by Isabelle Thomassin-Naggara.

Informed consent

Written informed consent was obtained from all patients included in the EURAD study.

Ethical approval

According to French regulations at the time of study initiation, the study was approved by a national committee (Comité Consultatif sur le Traitement de l’Information en matière de Recherche dans le domaine de la Santé, CCTIRS, approval no. 13.090).

Study subjects or cohorts overlap

One study has been previously published on the same cohort:

Thomassin-Naggara I, Poncelet E, Jalaguier-Coudray A, Guerra A, Fournier LS, Stojanovic S, et al Ovarian-Adnexal Reporting Data System Magnetic Resonance Imaging (O-RADS MRI) Score for Risk Stratification of Sonographically Indeterminate Adnexal Masses. JAMA Netw Open [Internet]. 2020 Jan 24 [cited 2020 Oct 13];3(1). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6991280/

Methodology

• retrospective

• diagnostic study

• performed at one institution on a multicentric database

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Thomassin-Naggara, I., Belghitti, M., Milon, A. et al. O-RADS MRI score: analysis of misclassified cases in a prospective multicentric European cohort. Eur Radiol 31, 9588–9599 (2021). https://doi.org/10.1007/s00330-021-08054-x

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  • DOI: https://doi.org/10.1007/s00330-021-08054-x

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