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Comparison of O-RADS, GI-RADS, and IOTA simple rules regarding malignancy rate, validity, and reliability for diagnosis of adnexal masses

  • Ultrasound
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Abstract

Objective

The American College of Radiology (ACR) recently published the ovarian-adnexal reporting and data system (O-RADS) to provide guidelines to physicians who interpret ultrasound (US) examinations of adnexal masses (AM). This study aimed to compare the O-RADS with two other well-established US classification systems for diagnosis of AM.

Methods

This retrospective multicenter study between May 2016 and December 2019 assessed consecutive women with AM detected by the US. Five experienced consultant radiologists independently categorized each AM according to O-RADS, gynecologic imaging reporting and data system (GI-RADS), and international ovarian tumor analysis (IOTA) simple rules. Pathology and adequate follow-up were used as reference standards for calculating the validity of three US classification systems for diagnosis of AM. Kappa statistics were used to assess the inter-reviewer agreement (IRA).

Results

A total of 609 women (mean age, 48 ± 13.7 years; range, 18–72 years) with 647 AM were included. Of the 647 AM, 178 were malignant and 469 were benign. Malignancy rates were comparable to recommended rates by previous literature in O-RADS and IOTA, but higher in GI-RADS. O-RADS had significantly higher sensitivity for malignancy than GI-RAD and IOTA (p = 0.003 and 0.0007, respectively), but non-significant slightly lower specificity (p > 0.05). O-RADS, GI-RADS, and IOTA showed similar overall IRA (κ = 0.77, 0.69, and 0.63, respectively) with a tendency toward higher IRA with O-RADS than with GI-RADS and IOTA.

Conclusions

O-RADS compares favorably with GI-RADS and IOTA. O-RADS had higher sensitivity than GI-RADS and IOTA simple rules with relatively similar specificity and reliability.

Key Points

• The malignancy rates were comparable to recommended rates by previous literature in O-RADS and IOTA, but higher in GI-RADS.

• The O-RADS had significantly higher sensitivity for malignancy than GI-RADS and IOTA (96.8% vs 92.7% and 92.1%; p = 0.003 and 0.0007, respectively), but non-significant slightly lower specificity (92.8% vs 93.6% and 93.2%, respectively; p > 0.05).

• The O-RADS, GI-RADS, and IOTA showed similar overall inter-reviewer agreement (IRA) (κ = 0.77, 0.69, and 0.63, respectively), with a tendency toward higher IRA with O-RADS than with GI-RADS and IOTA.

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Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

AM:

Adnexal masses

AUC:

Area under the curve

FIGO:

Federation of Gynaecology and Obstetrics

GI-RADS:

Gynecologic Imaging Reporting and Data System

IOTA:

International Ovarian Tumor Analysis

IRA:

Inter-reviewer agreement

O-RADS:

Ovarian-Adnexal Reporting and Data System

ROC:

Receiver operating characteristic

US:

Ultrasound

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Acknowledgments

The authors thank all staff members and colleagues in the Radiology and Obstetrics& Gynecology Departments at Zagazig and Benha Universities, and Al-Ahrar Teaching Hospital for their helpful cooperation.

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Radio-diagnosis, Zagazig University, Zagazig, Egypt

    Mohammad Abd Alkhalik Basha, Maha Ibrahime Metwally, Ahmed A. El Sammak, Mohamed M. A. Zaitoun, Enass M. Khattab, Taghreed M. Azmy, Nader Ali Alayouty, Nesreen Mohey, Hosam Nabil Almassry & Hala Y. Yousef

  2. Department of Radio-diagnosis, Al-Ahrar Teaching Hospital, Zagazig, Egypt

    Shrif A. Gamil

  3. Department of Radio-diagnosis, Benha University, Benha, Egypt

    Hamada M. Khater, Sameh Abdelaziz Aly & Hesham Youssef Algazzar

  4. Department of Obstetrics & Gynecology, Zagazig University, Zagazig, Egypt

    Safaa A. Ibrahim & Ekramy A. Mohamed

  5. Department of Clinical Oncology, Zagazig University, Zagazig, Egypt

    Abd El Motaleb Mohamed

  6. Department of Clinical Pathology, Zagazig University, Zagazig, Egypt

    Amira Hamed Mohamed Afifi

  7. Department of Pathology, Zagazig University, Zagazig, Egypt

    Ola A. Harb

Authors
  1. Mohammad Abd Alkhalik Basha
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  2. Maha Ibrahime Metwally
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  7. Mohamed M. A. Zaitoun
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  12. Hosam Nabil Almassry
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  14. Safaa A. Ibrahim
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  16. Abd El Motaleb Mohamed
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  17. Amira Hamed Mohamed Afifi
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  18. Ola A. Harb
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  19. Hesham Youssef Algazzar
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Corresponding author

Correspondence to Mohammad Abd Alkhalik Basha.

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Guarantor

The scientific guarantor of this publication is the corresponding author: Mohammad Abd Alkhalik Basha.

Conflict of interest

The author of this manuscript declare no relevant conflicts of interest, and no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

The corresponding author has great statistical expertise

Informed consent

Written informed consent was obtained from all patients.

Ethical approval

Institutional review boards’ approval was obtained.

Study subjects or cohorts overlap

A subset of the data, on 258 of the 609 women, was previously published [Basha, M.A.A., Refaat, R., Ibrahim, S.A. et al. Eur Radiol (2019) 29: 5981. https://doi.org/10.1007/s00330-019-06181-0]. The prior study evaluated diagnostic performance and IRA of the GI-RADS for diagnosis of AM by US; in the current study, we compared the O-RADS with GI-RADS and IOTA regarding their validity and reliability for the US diagnosis of AM.

Methodology

• Retrospective

• Diagnostic or prognostic study

• Performed at multiple centres

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Basha, M.A., Metwally, M.I., Gamil, S.A. et al. Comparison of O-RADS, GI-RADS, and IOTA simple rules regarding malignancy rate, validity, and reliability for diagnosis of adnexal masses. Eur Radiol 31, 674–684 (2021). https://doi.org/10.1007/s00330-020-07143-7

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