Are you aware of (O-RADS)? How important is this method for diagnosing ovarian problems?

It's normal to feel very scared when a scan reveals a change or a problem (a lesion) in the ovaries or the areas surrounding them (we call these `(adnexal)` areas). But don't worry. There is a special method that helps doctors in such cases and provides you with more accurate information. That method is called `(O-RADS)`. Let's talk about this simply today.

What is (O-RADS)? Let's understand exactly!

O-RADS™ stands for Ovarian-Adnexal Reporting and Data System. Simply put, it's a special tool that doctors use. Do you know what it's for? It's used to classify any lesions, changes, or lumps that are found on a scan of your ovaries (or the surrounding areas, which are what we call the adnexals—the fallopian tubes, ovaries, and the connective tissue that holds the organs of your reproductive system together).

According to the O-RADS system, a lesion is graded on a scale of 0 to 5. The higher the number, the higher the risk of developing cancer . Here's how it works:

• O-RADS 0: This means that the information from the scan cannot be used to make an accurate assessment, and further testing is needed. The scan may not be clear.
• O-RADS 1: This is the best result! It means your ovaries are healthy and normal.
• O-RADS 2: Here, even if there is a `(lesion)`, the chance of it being cancerous is very low (often less than 1%). These are usually considered `(benign)`, meaning they are not cancerous.
• O-RADS 3: Here, there is a small chance that cancer may be present, but it is low (usually between 1% and 10%). Doctors are a little more concerned about these, and may ask you to do another scan in a little while.
• O-RADS 4: Here, the chance of cancer is at a moderate level (usually between 10% and 50%). These are a bit suspicious. So doctors may do further tests on this, and may refer you to a specialist.
• O-RADS 5: This means that the risk of cancer is very high (often more than 50%). In this case, immediate action is required.

But O-RADS is more than just a classification system. The committee that developed it (which originated with the American College of Radiology) has also developed a lexicon (a set of standard words used to describe what is seen on scans - called a lexicon) and recommendations for what treatments are appropriate for people in each risk group. This is a great help for doctors in making decisions.

When is O-RADS used?

Your doctor may use this ``(O-RADS)`` system to identify and classify things like:

• Ovarian cysts: These are lumps that form on your ovaries. Some cysts are just fluid-filled sacs and aren't dangerous. But some are something to be concerned about.
• Adnexal masses: Tumors or masses that form in the fallopian tubes or in the ligaments that hold the organs of the reproductive system together. These can also be of different types.

So, if a condition like this is seen on a scan, O-RADS helps to understand its exact nature and assess how risky it is.

What are the main methods of (O-RADS)?

There are two main "sections" of O-RADS, depending on the type of scan used. That is, it varies slightly depending on the type of scan used to obtain the information.

(O-RADS Ultrasound - US)

This is the main and primary method used in O-RADS. Here, either an abdominal ultrasound or a transvaginal ultrasound is used. As you know, an ultrasound is a method of taking pictures of the inside of the body using sound waves.

Ultrasound technology can see the ovaries and their associated lesions very clearly. Transvaginal ultrasound in particular can produce very clear images because it can be done very close to the ovaries.

(O-RADS MRI)

Magnetic Resonance Imaging (MRI) is a test that provides more detailed information about the soft tissues of our body. MRI uses magnetic fields and radio waves. It is a more complex and expensive test than ultrasound.

If doctors do not have enough information from an ultrasound, or if they need more information to make a diagnosis, or if it is difficult to confirm whether a condition is cancerous or not, this MRI method is used. O-RADS MRI is the process of analyzing MRI images and classifying them into O-RADS.

What actually happens with (O-RADS)? What is the significance of this?

The O-RADS system has several main objectives. These are very important for you and your doctors.

• Providing consistent interpretations for test reports: Imagine how much of a problem it would be if you had to interpret a scan report one way when you went to one doctor and another way when you went to another? Because of O-RADS, every doctor and hospital in the United States (and now in many countries around the world) classifies ovarian and related lesions in the same, standardized way. This means that no matter where you get treatment, the report will mean the same thing. This eliminates a lot of confusion.

• Increasing diagnostic accuracy: In ovarian and related lesions, O-RADS reduces the chance of false positives for malignancy. It also reduces unnecessary surgery for benign conditions. O-RADS analyzes the characteristics of a lesion (e.g., size, shape, and contents) in a very scientific manner.

• Providing treatment recommendations for each category: Through the `(O-RADS)` system, doctors receive standard treatment recommendations for each risk category (which is O-RADS 0 to 5). For example, for someone with an O-RADS category of 2, a recommendation like, "There's nothing to worry about, this is probably harmless, we'll check back in a little while." But for an O-RADS 4 or 5, a recommendation like, "We need to do more tests on this soon and refer you to a specialist if necessary" is given.

What are the advantages of the (O-RADS) system? Why is it good for you?

Research has shown that ovarian cancer screening tests using transvaginal ultrasound and the tumor marker CA-125 can sometimes give false positive results. That means you may be diagnosed with cancer, but later find out you never had cancer. Imagine the stress and anxiety that would come with that! Perhaps even having to undergo surgery for no reason?

Sometimes, patients undergo surgery even when it is not really necessary. Importantly, surgeries performed for non-cancerous ``benign`` ``lesions`` have a complication rate of 17.8%. In other words, a significant proportion of people who undergo unnecessary surgery develop health problems related to the surgery.

The O-RADS system takes into account several factors. For example, the characteristics of the lesion (size, location, appearance, whether there is solid material inside, blood supply, etc.) and whether you have gone through menopause. This is because if a new lesion develops on an ovary in someone who has gone through menopause, you should be a little more concerned about it.

The primary goal is to reduce unnecessary surgery for people with noncancerous lesions. Another goal is to quickly refer people with suspicious or cancerous lesions to a more appropriate specialist (for example, a gynecologic oncologist). Therefore, you will only be referred for surgery if you absolutely need it.

Who created the (O-RADS) system?

Such an important system doesn't just happen overnight, does it? In 2018, the American College of Radiology, the leading radiology organization in the United States, sponsored a committee of international physicians representing various fields of expertise (such as gynecology, radiology, and oncology), and developed the O-RADS system. The O-RADS US - Ultrasound committee even updated the lexicon in November 2022. This means that it is a system that is constantly updated with new knowledge.

What relief do you get from this?

It's normal to feel like the world has stopped and you feel a heavy weight on your heart when you find out that something suspicious has come out of your scan. As you undergo more tests to confirm a diagnosis or to make sure that nothing is wrong, your anxiety and fear can increase day by day.

However, the O-RADS method reduces the chance of you getting false-positive test results. That means you're less likely to be diagnosed with cancer when you don't actually have it. That also reduces the risk of unnecessary surgery. The O-RADS method helps you get the answers you need faster and more accurately. Isn't that a huge relief?

Take-Home Message

The most important things you need to remember from what we've talked about are these:

• O-RADS is a very important, standardized, and scientific method that helps doctors identify and classify ovarian and related problems (lesions).
• This method results in more accurate diagnoses, fewer unnecessary surgeries, and clearer guidance on what treatments you need.
• If your scan report has an O-RADS classification, talk to your doctor about it and learn more. Don't worry, these methods are here to help you.
• Remember, early diagnosis and proper treatment are the best ways to live a healthy life. Therefore, follow your doctor's advice and get the necessary tests.

I hope you find this information useful!

` O-RADS, Ovarian, Adnexal, Lesion, Ultrasound, MRI, Cancer, Gynecology