0:01

So here is a breakdown of the ORADS categories.

0:04

So we've got ORADS 0, which is an

0:06

incomplete evaluation, and then ORADS 1

0:09

is the normal physiologic ovary.

0:13

ORADS 2 is almost certainly benign,

0:16

so very low risk of malignancy.

0:18

ORADS 3 have a low risk of malignancy

0:21

between 1% to 10%, and then ORADS 4

0:24

have an intermediate risk, 10% to 50%.

0:27

And then ORADS 5 are the classic

0:30

malignant-looking lesions with a high

0:32

risk of malignancy of greater than 50%.

0:35

Okay, so we'll briefly go through

0:37

the different ORADS categories.

0:39

I won't spend a whole bunch of time on this

0:41

because you can review the document

0:43

yourself, but I just wanted to show you

0:45

in picture format what we're looking at.

0:48

So the major categories for ORADS lexicon

0:51

include physiologic group, which refers

0:55

to normal ovarian physiology and a

0:58

lesion, which is not normal physiology.

1:01

So the first step is to determine, is this a

1:04

physiologic appearance or is this a lesion?

1:08

And then we can look at the size of the lesion.

1:11

Then we look at whether there

1:12

are any solid components.

1:14

So look at the external contour, the internal

1:16

contents, the inner margin or walls, and

1:19

the vascularity, which is the color score.

1:23

On this slide, I have an image from the

1:26

article that goes through the color score.

1:29

So basically, the range is no flow, to

1:32

minimal, to moderate, to very strong flow.

1:35

And this is a little bit subjective

1:37

because obviously minimal, moderate,

1:39

and strong are subjective features.

1:42

But I just wanted you to be aware that

1:44

that is how flow is categorized on ORADS.

1:49

And then we've got general and extra

1:51

ovarian findings, which include fluid,

1:53

ascites, and peritoneal nodules.

1:56

So ORADS 1 is a normal ovary.

1:59

So physiologic, no likelihood

2:01

of malignancy or less than 1%.

2:03

So again, we've talked about these.

2:05

We've got a follicle, a corpus luteum

2:07

cyst, and those are pretty commonly seen.

2:09

And if you're just starting out with

2:11

ovarian imaging, Initially when you see

2:14

a corpus luteum cyst, you might be a

2:15

little bit concerned because the wall

2:17

looks thick and there's a lot of flow

2:19

around it, and that sometimes looks scary.

2:21

But over time, more commonly, you'll see

2:23

these, and you'll be much more comfortable

2:25

calling them corpus luteum cysts.

2:28

ORADS 2 is the almost certainly benign category.

2:32

So that is characterized by a few

2:34

lesions, including a simple cyst.

2:37

So those are lesions or simple cysts

2:40

that are between 3 and 10 centimeters

2:42

in premenopausal women and less than

2:45

10 centimeters in postmenopausal women.

2:47

So notice that Again, that 10

2:49

centimeter rule comes into play here.

2:51

So even postmenopausal women can have

2:54

simple cysts that are up to 10 centimeters

2:57

in size that are not concerning for cancer.

3:00

And then we've got the classic benign

3:02

lesions like an endometrioma or a

3:05

hemorrhagic cyst or other non-simple cysts.

3:09

So here we've got a cyst that has a

3:11

partial septation or an incomplete

3:13

septa, and that's also considered benign.

3:16

ORADS 2.

3:17

And then hemorrhagic cyst, dermoid cyst, and

3:20

typical endometrioma, there's a variety of

3:23

sonographic appearances that we see here.

3:25

And again, over time, we start to see

3:28

these patterns and these variations,

3:31

but we feel more comfortable with

3:32

calling these lesions the more we see.

3:34

So again, we've got a very typical retracting

3:37

clot, angular margins without flow in one

3:41

of these patients for a hemorrhagic cyst.

3:45

The other ORADS 2 lesions are some of the

3:48

paraovarian lesions, so that includes

3:50

simple paraovarian cyst, peritoneal

3:53

inclusion cyst, and hydrosalpinges.

3:55

Those are all ORADS 2.

3:58

ORADS 3 has a low risk of malignancy, and here

4:02

we are a little bit more dependent on size.

4:05

So once you get to or just above 10 centimeters,

4:09

even if it's a unilocular, simple or non-

4:12

simple cyst, that's considered ORADS 3.

4:14

Some of the typical ORADS 2 benign

4:17

lesions like hemorrhagic cyst, dermoid,

4:19

and endometrioma, again, if they're more

4:21

than 10 centimeters, that's ORADS 3.

4:24

And then as we start to get more

4:25

complex features, like an irregular

4:28

inner wall, a multilocular cyst, or a

4:31

solid component with a low amount of

4:34

flow, those are considered ORADS 3.

4:38

So I had this piece just cross my desk in the

4:42

last week, so I thought I would put it in here.

4:44

So this is an eight centimeter cystic mass.

4:47

So you can see that it's got several locules

4:50

in it, but the walls are really quite thin.

4:52

So if we go back to ORADS 3 here,

4:54

this is a multilocular cyst

4:57

with a smooth inner wall.

4:58

It's less than 10 centimeters.

5:00

I don't have the color score in this

5:02

case because I didn't have the ultrasound

5:04

at the time of reporting, but presuming

5:06

that we have a low color score.

5:08

In this case, this would be an ORADS 3

5:10

just based on its size of 8 centimeters.

5:14

If this lesion was 10 centimeters

5:16

or more, this would be ORADS 4.

5:20

So now, ORADS 4 is an intermediate risk category.

5:23

So the risk of malignancy is

5:25

now between 10 and 50 percent.

5:27

And here we're getting, again, larger

5:30

lesions, more than 10 centimeters, more flow.

5:34

So everything is kind of more: more nodules,

5:37

more wall thickening, more blood

5:38

flow, more solid components, etc.

5:41

So you can see that the complexity

5:43

of the lesions is increasing as

5:45

the ORADS risk category increases.

5:49

And then finally, ORADS 5, high risk

5:52

of malignancy of 50 percent or more.

5:54

And here, the difference between ORADS 4

5:57

and 5 is really just the number of the solid

6:00

components, the color score, and the volume

6:03

that's occupied by the solid component.

6:06

And as soon as we see ascites and

6:08

peritoneal nodules again, those alarm

6:10

bells go off for a risk of malignancy.