Improved Accuracy with Updated O-RADS US Guidelines
The Ovarian-Adnexal Reporting and Data System for Ultrasound (O-RADS US) is a standardized tool that radiologists use to classify ovarian and adnexal lesions by cancer risk. A 2022 update has made the system more accurate, reducing false positives and improving specificity, as featured in a recent RSNA News article.
How O-RADS US 2022 Improves Accuracy
In a University of Chicago study, 5.3% of patients were reclassified into lower cancer risk categories with the updated version compared to 2019 guidelines. "It's exactly what we hoped would happen," said Lori Strachowski, MD, co-chair of the O-RADS initiative governed by the American College of Radiology and Professor Emeritus in the Department of Radiology and Biomedical Imaging and Obstetrics, Gynecology, and Reproductive Sciences at the University of California, San Francisco (UCSF). 
Key Updates in O-RADS US 2022
As shared in RSNA News,
- "New descriptors: bilocular cysts and acoustic shadowing to improve diagnostic specificity of lower-risk lesions.
- Expanded lexicon for classic benign lesions.
- Updated management guidelines, allowing the option for short-term US follow-up for O-RADS 3 category cystic lesions.
- Better alignment with existing consensus statements."
Clinical Impact
According to lead researcher Ryan Longman, MD, section chief of OB/GYN, US, Genetics and Fetal Neonatal Care Center at UChicago, "The O-RADS US version 2022 is superior to version 2019. It maximizes sensitivity while significantly improving the specificity of lower-risk lesions." This means fewer unnecessary surgeries and less follow-up imaging for patients.
Dr. Strachowski noted that more updates are planned for 2026, including MRI management recommendations and improved lexicon alignment.