ArticleInternational journal of women's health2026
A Simple O-RADS-Based Ultrasound Scoring System for Risk Stratification of Ovarian Cystic Lesions: A Multicenter Study.
Article in International journal of women's health, 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
Objective: To develop and validate a simple and practical scoring system based on O-RADS ultrasound features for distinguishing benign from malignant ovarian cystic lesions. Methods: This multi-institutional retrospective study included women with ovarian cystic lesions who underwent pelvic ultrasound and had either histopathological confirmation or at least 2 years of imaging follow-up. Participants were randomized into training (70%, n=1715) and internal validation (30%, n=711) sets, with an external validation set (n=278) from another center. Univariate and multivariate logistic regression identified independent O-RADS predictors of malignancy, which were assigned weights to construct a scoring system. Performance was validated internally and externally, and compared with O-RADS. Inter-observer agreement was assessed between two junior sonographers and two senior sonographers. Results: Seven independent predictors were identified: maximum diameter ≥10 cm (score 2), solid component (2), irregular internal wall (2), color score 3-4 (2), ascites (2), >3 papillary projections (1), and acoustic shadowing (-2), with an optimal cutoff value of 4 points. In the training set, the scoring system achieved an AUC of 0.973, sensitivity of 95.3%, and specificity of 92.5%, compared to O-RADS (AUC of 0.954, sensitivity of 97.3%, specificity of 86.7%). The scoring system maintained stable performance in internal validation (AUC of 0.968, sensitivity of 93.8%, specificity of 91.8%) and external validation (AUC of 0.964, sensitivity of 93.0%, specificity of 90.2%). Inter-observer agreement was excellent among all sonographers (κ=0.80, p<0.001), as well as between junior (κ=0.82) and senior (κ=0.79) sonographers. Conclusion: The O-RADS-based scoring system demonstrated excellent and stable diagnostic performance, potentially offering a simple and practical tool for clinical practice; however, prospective multicenter validation in diverse populations is warranted before widespread adoption.
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