In the summer of 2015, the ACR Ovarian-Adnexal Reporting and Data System (O-RADS™) Committee was formed with the purpose of creating a standardized lexicon for describing the imaging characteristics of ovarian and adnexal masses and applying it to a risk stratification and management system for evaluation of malignancy. That goal and its impact on improving women’s health is what drives Rochelle F. Andreotti, MD, FACR, chair of the O-RADS Committee and professor of clinical radiology, clinical obstetrics, and gynecology at Vanderbilt University Medical Center in Nashville, Tenn. In a recent interview with the ACR, Andreotti shared the impact that O-RADS has on the specialty — and on women’s health.
What is O-RADS and what is its importance for improving quality and safety?
O-RADS is one of nine published ACR reporting and data systems for quality and safety (Q&S). It functions as a quality assurance tool and clinical support system for standardized description of ovarian/adnexal pathology and its management. The system includes a common lexicon that radiologists can use to categorize all levels of risk and assign associated management strategies.
There is a critical need for O-RADS. Too much unnecessary surgery is performed for benign ovarian/adnexal lesions. Most of these lesions are physiologic, non-neoplastic or benign neoplasms; and ovarian cancer is lethal, but rare. Surgery-associated morbidity has also been reported to be as high as 15%. On the other hand, initial surgery is frequently performed by a general gynecologist when there are much better outcomes with malignancy when management is by a gynecologic oncologist.
For all of these reasons, we need guidelines to manage benign disease conservatively and to know when to refer patients to a gynecologic oncologist when there is significant suspicion of malignancy. This is where O-RADS comes into play. The goal is to optimize ovarian cancer outcomes while minimizing unnecessary surgery in patients at low risk of malignancy.
What has been the journey of the O-RADS Committee in developing these guidelines?
O-RADS is an international initiative that has involved extensive collaboration with competing national and international societies. Our membership was primarily derived from several major initiatives that prompted our formation, including:
- "The Society of Radiologists in Ultrasound Consensus Statement,” a North American initiative helpful in determining management of cystic lesions
- The International Consensus, the first collaboration of European and North American management approaches promoting a more conservative, standardized approach while optimizing the referral pattern to a gynecologist when malignancy is suspected
- Terms and risk stratification models developed by the International Ovarian Tumor Analysis Group (IOTA)
The Committee also consisted of members representing national and international societies who could contribute to and eventually help promote our system. As a result, development of the O-RADS guidelines has been a collaborative, multidisciplinary, international effort that brings together two US approaches:
- The pattern-based approach commonly used in North America
- European-based IOTA models with the incorporation of the Assessment of Different NEoplasias in the adneXa (ADNEX) model, a mathematical risk prediction model
What has been the work of the O-RADS Committee to date?
The O-RADS Committee comprises two parallel working groups with experts in radiology, gynecology, gynecologic oncology, and pathology: one for US, which is the primary modality, and another for MRI, which is a secondary, problem-solving tool. Both groups have members representing multiple national and international imaging and non-imaging organizations. In addition to chairing the entire committee, I have chaired and have been primarily involved with the US Working Group, and Caroline Reinhold, MD, MSc, associate chair and professor of radiology and gynecology at McGill University Health Center in Montreal, has chaired the MRI Working Group.
Our first phase was the development of a lexicon, a practical uniform vocabulary where we describe the imaging characteristics of ovarian and adnexal lesions. In phase two, the lexicon was applied to risk stratification, which is critical for consistent follow-up and management. Only O-RADS US includes management strategies, although these management recommendations may include an MRI.
Collectively, the members of the O-RADS Committee feel that this system will have a significant impact on the practice of radiology and women’s healthcare by emphasizing structured classification and reporting of adnexal masses.
What steps should radiologists take to improve Q&S for ovarian and adnexal mass patient care?
First, one must understand that to have the highest quality of care, everyone needs to be speaking the same language, which we hope to be the lexicon of O-RADS. This begins with the two general categories of findings that are either physiologic or lesions and continues with the five main subcategories of lesions. In addition, a uniform lexicon will permit the collection of reports employing structured tools, providing the opportunity for data scientists to improve outcomes research and ultimately improve ovarian cancer detection rates. Across the board, we all need to use the same terminology.
With terminology in place, we can use the common lexicon to assign the lesion to the correct risk category and recommend appropriate management. Patients with benign-appearing lesions can be offered conservative management, preventing unnecessary surgery. Patients with lesions of higher risk of malignancy in the O-RADS category 3 can be managed by a gynecologist using minimally invasive surgery. Those in O-RADS categories 4 and 5 would need involvement of the gynecologic oncologist for appropriate supervision of care.
How do you hope your contributions to O-RADS will impact the specialty and women’s health in general?
Collectively, the members of the O-RADS Committee feel that this system will have a significant impact on the practice of radiology and women’s healthcare by emphasizing structured classification and reporting of adnexal masses. As for me, any success that I have had in the field of medicine can be attributed to a desire to influence and leave this world a little better in some way. My hope is that this data system will make a meaningful contribution as my legacy to women’s healthcare.