ArticleQuantitative imaging in medicine and surgery2026
Ultrasonographic assessment of pediatric adnexal lesions: validation of the O-RADS system and development of a simplified C-CAS framework.
Article in Quantitative imaging in medicine and surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The Ovarian-Adnexal Reporting and Data System (O-RADS) ultrasound (US) is a standardized tool for assessing adult adnexal lesions, but its performance in the pediatric population has not been fully validated. This study aimed to validate O-RADS US in children and develop a simplified assessment framework for pediatric adnexal lesions. Methods: This retrospective study included a training cohort of 301 adnexal lesions from three centers and an independent validation cohort of 95 lesions from a fourth center. All lesions were pathologically confirmed. In the training cohort, lesions were classified according to the O-RADS V2022 criteria, and the diagnostic performance of the system was evaluated. Independent predictors of malignancy identified by firth penalized regression were used to construct a simplified framework [Cysts-Color-Ascites-Shadowing (C-CAS)]. This C-CAS framework was subsequently tested in the validation cohort. Results: Of the 396 lesions, 44 (11.11%) were malignant. In the training cohort, O-RADS showed excellent diagnostic performance [area under the curve (AUC) =0.931, 95% confidence interval (CI): 0.898-0.964]. Using a cutoff of category ≥4, sensitivity was 97.2% (95% CI: 91.9-100.0), specificity 89.1% (95% CI: 85.3-92.8%), positive predictive value 54.7% (95% CI: 42.5-66.9%), and negative predictive value 99.6% (95% CI: 98.8-100.0%). Firth regression analysis confirmed that "color score 4" [odds ratio (OR) =21.78, 95% CI: 1.80-255.38, P=0.012] and "ascites" (OR =49.13, 95% CI: 4.25-417.96, P<0.001) were strong independent predictors of malignancy, whereas "uni- or bilocular cyst without solid component" (OR ≈0.00, 95% CI: 0.00-0.04, P<0.001) and "acoustic shadowing" (OR =0.04, 95% CI: 0.00-0.45, P=0.004) were significant protective factors. The derived C-CAS framework achieved an AUC of 0.932 (95% CI: 0.911-0.953) in the training set and maintained high diagnostic accuracy in the independent validation set (AUC =0.948, 95% CI: 0.916-0.980). Conclusions: O-RADS US is a clinically applicable tool for pediatric adnexal lesions. The proposed C-CAS framework offers a validated, simplified alternative which maintains high diagnostic accuracy.
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