E2140. Adnexal Lesions at Ultrasound: A Walk Through the O-RADS, SRU, and IOTA Guidelines With a Closer Look on O-RADS
  1. Lauren Shreve; Hospital of the University of Pennsylvania
  2. Kheng Lim; Hospital of the University of Pennsylvania
In North America, there is a growing momentum in enhancing value in healthcare based on evidence-based medicine. In radiology, we are observing a growing trend and acceptance to standardize reporting of benign and malignant lesions. The American College of Radiology (ACR) has championed this effort by sponsoring the reporting and data system (RADS). The goals of this exhibit are: To review the ultrasound features of benign and malignant adnexal lesions. Apply the ultrasound features using the guidelines put forth by national and international societies (SRU, ACR, IOTA). To aid the readers in choosing a guideline of their choice to apply in their daily clinical practice.

Educational Goals / Teaching Points
Present background and reasoning behind the trends of using standardized reporting and data system sponsored by the ACR. Review of Society of Radiologists in Ultrasound (SRU) guidelines in management of ovarian cysts and its approach to simple adnexal cysts which was updated in 2019. Review of ACR-sponsored Ovarian-Adnexal Reporting and Data System (ORADS) Review of International Ovarian Tumor Analysis (IOTA) group approach using “Simple Rules” and multivariable logistic regression model to estimate risk.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Features of benign ovarian lesions: hemorrhagic cyst, dermoid, endometrioma, corpus luteum. Features of benign adnexal lesions: paraovarian cyst, peritoneal inclusion cyst, hydrosalpinx. Size as a a determinant to follow-up of simple ovarian cyst. Multilocular feature as a determinant to likelihood of malignancy and its relationship to cyst size. Solid component in a cyst as a suspicious feature for malignancy. Discussion of color Doppler flow grading in O-RADS. Examples of developing dictation macros and embedded pick list options to facilitate recall of knowledge and consistency in application of the guidelines chosen by one's practice. Examples using O-RADS are presented.

Having a general knowledge of the malignant features of ovarian lesions is paramount in accurate diagnosis and avoiding overcall. Developing pick list options embedded in dictation macros can facilitate consistent and accurate diagnosis adhering to evidence-based guidelines.