O-RADS US v2022: Assessment Categories and Risk Stratification of Adnexal Lesions
O-RADS US (Ovarian-Adnexal Reporting and Data System) is a consensus-based risk assessment system for adnexal ovarian lesions developed by the ACR committee. The current version is O-RADS US v2022 (release date: November 2022). The system relies on standardized ultrasound lexicon of descriptors and integration of the IOTA model, with management strategy differentiated by premenopausal and postmenopausal patient status.
O-RADS US v2022 Assessment Categories
| Category | Description | Management |
|---|---|---|
| O-RADS 0 | Incomplete evaluation — lesion features cannot be accurately characterized due to technical factors | Repeat ultrasound or MRI |
| O-RADS 1 | Normal ovary — no adnexal lesion present | None [N/A] |
| O-RADS 2 | Almost certainly benign (physiologic cysts, simple cysts, etc.) | By subtype and size |
Classification Examples per v2022
According to the published O-RADS US v2022 table:
- Physiologic cyst: follicle (≤3 cm) or corpus luteum (typically <3 cm) — category 1, no follow-up required.
- Simple cyst >3 cm to 5 cm: management — no follow-up (None).
- Simple cyst >5 cm but <10 cm: follow-up ultrasound at 12 months.
- Solid lesion with acoustic shadowing, smooth margins, any size, color signal (CS) = 1: classified as classic benign pattern.
Categories 2 and above utilize lexicon descriptors and the IOTA model for risk assessment. Higher categories (up to 5) correspond to increasing malignancy probability; specific thresholds and management for categories 3–5 are not detailed in the provided excerpts [clarification needed].
Practical Principles of Application
For correct system application, it is important to apply appropriate lexicon terminology to classic benign lesions — this prevents false category elevation. Ambiguous descriptive terms such as "complex" or "heterogeneous" lesion should be avoided.
Frequently asked questions
What is the current version of O-RADS US?
O-RADS US v2022, release date November 2022 (ACR). It includes assessment categories and a list of classic benign lesions.
What does O-RADS 0 mean?
Incomplete evaluation: lesion features cannot be accurately characterized due to technical factors. Repeat ultrasound or MRI is recommended.
How is a simple cyst >5 cm but <10 cm classified?
According to v2022 table, such a simple cyst is recommended for follow-up ultrasound at 12 months.
Does the system account for menopausal status?
Yes, management strategy in O-RADS US v2022 is differentiated for premenopausal and postmenopausal patients and integrates the IOTA model.
How can category overestimation be avoided?
Apply appropriate lexicon terminology to classic benign findings and avoid ambiguous descriptors such as "complex" or "heterogeneous".