Diagnostic accuracy and risk stratification of ultrasound O-Rads in ovarian tumors: A prospective clinico-histopathological correlation study

Introduction:Ovarian cancer is among the leading causes of gynaecological cancer mortality worldwide, often diagnosed at an advanced stage due to nonspecific symptoms and limited early detection methods. The Ovarian-Adnexal Reporting and Data System (O-RADS) provide a standardized ultrasonographic classification that may improve preoperative discrimination between benign and malignant ovarian tumors.Aims and Objective: To assess the risk stratification of adnexal masses on the basis of ORADS and evaluate the diagnostic performance of O-RADS ultrasound scoring system in predicting ovarian malignancy and correlate radiologic findings with Histopathological Examination (HPE).Material and Methods: This observational study included 164 women presenting with adnexal masses at a tertiary care center, central India. Clinical profiles, imaging findings using USG with O-RADS scoring, and postoperative histopathological results were analyzed. The sensitivity, specificity, PPV and NPV of O-RADS for predicting malignancy were calculated.Results: There was a significant positive correlation between the distribution of benign and malignant tumours across ORADS grades, malignancy risk increases significantly from O-RADS 3 to O-RADS 5, demonstrating strong diagnostic reliability. Higher ORADS Grades were had loculated tumours, irregular margins, septations, solid component, and higher echogenicity. In the ORADS Grade 1, 2 and 3, did not have any malignancy. ORADS grade 4 and 5 had higher prevalence of malignancy.Conclusions: Ovarian-Adnexal Reporting and Data System US risk stratification and management system had higher sensitivity and specificity for detection of adnexal malignancy. O-RADS are an effective and reliable scoring system to categorize adnexal masses based on their risk of malignancy and demonstrate strong correlation with histopathology. Implementation of this classification may reduce unnecessary surgeries and improve referral strategies.