Low Risk (1 to <10%). e.g., large simple cysts >10cm, multilocular without solid parts <10cm.
O-RADS 4
Intermediate Risk (10 to <50%). e.g., multilocular >10cm, solid components with low blood flow.
O-RADS 5
High Risk (≥50%). e.g., ascites, solid masses with high blood flow (Color 4), ≥4 papillae.
Section 3
Pearls/Pitfalls
Key Nuances
O-RADS beautifully synthesizes the "IOTA Simple Rules" and the "IOTA ADNEX model" into one cohesive management algorithm.
A completely anechoic "simple cyst" in a premenopausal woman is O-RADS 2, even up to 10cm! Classic radiology used to flag 5cm cysts as highly suspicious; O-RADS stops this over-referral.
Any irregularity in solid components, or vascularity (Color Score 4) in solid tissues, radically spikes the risk into O-RADS 5.
Section 4
Next Steps
Management Triggers
01
O-RADS 1 & 2: Routine care. Follow-up only if symptomatic or pre-specified sizes. Handled by primary care / general gyn.
02
O-RADS 3: Conservative management via ultrasound surveillance (e.g., 3-6 months), or consultation with general gynecologist for benign excision if symptomatic.
03
O-RADS 4: Management by a gynecologist in consultation with a Gyn Oncologist, OR perform Pelvic MRI (O-RADS MRI score) to re-stratify.
04
O-RADS 5: Mandatory referral to a Gynecologic Oncologist. Avoid surgical spillage at all costs.
Section 5
Evidence Appraisal
The ACR Endorsement
O-RADS US Risk Stratification and Management System: A Consensus Guideline from the ACR Ovarian-Adnexal Reporting and Data System Committee.
Andreotti RF et al. • Radiology.. 2020;The joint ACR/IOTA publication formalizing the dictionary and standardizing malignant risk percentages.
Section 6
Literature
American College of Radiology
Following the unprecedented success of BI-RADS for mammography, the ACR partnered with the IOTA group to create O-RADS, finally bringing order to the notoriously subjective landscape of pelvic ultrasonography.
