O-RADS 0 = Incomplete Evaluation

Recommendation: Repeat US study or MRI

O-RADS 1 = Normal Ovary

Recommendation: None

O-RADS 2 = Almost certainly benign (<1% risk of malignancy)

Recommendation:

Imaging:
No further imaging

Clinical:
Gynecologist referral as needed for Hydrosalpnix and Peritoneal Inclusion Cyst

O-RADS 2 = Almost certainly benign (<1% risk of malignancy)

Recommendation:

Imaging:
o Premenopausal:
• ≤5 cm: None
• >5 cm but <10 cm: Follow-up US in 2–3 months
o Early postmenopausal (<5 years):
• <10 cm, options to confirm include:
1. Follow-up US in 2–3 months or
2. US specialist (if available) or
3. MRI (with O–RADS MRI score)
o Late postmenopausal (≥5 years):
• Should not occur; recategorize using other lexicon descriptors.

Clinical:
Gynecologist referral as needed

O-RADS 2 = Almost certainly benign (<1% risk of malignancy)

Recommendation:

Imaging:
• ≤3 cm: May consider follow-up US in 12 months*
• >3 cm but <10 cm: If not surgically excised, follow-up US in 12 months*

Clinical:
Gynecologist referral as needed

* There is a paucity of evidence for defining the need, optimal duration or interval of timing for surveillance. If stable, consider US follow-up at 24 months from initial exam, then as clinically indicated. Specifically, evidence does support an increased risk of malignancy in endometriomas following menopause and those present greater than 10 years.

O-RADS 2 = Almost certainly benign (<1% risk of malignancy)

Recommendation:

Imaging:
o Premenopausal:
• <10 cm: If not surgically excised, follow-up US in 12 months* o Postmenopausal: • <10 cm and initial exam, options to confirm include 1. Follow–up US in 2–3 months or 2. US specialist (if available) or 3. MRI (with O-RADS MRI score) Then, if not surgically excised, recommend follow-up US in 12 months*

Clinical:
Gynecologist referral as needed

* There is a paucity of evidence for defining the need, optimal duration or interval of timing for surveillance. If stable, consider US follow-up at 24 months from initial exam, then as clinically indicated. Specifically, evidence does support an increased risk of malignancy in endometriomas following menopause and those present greater than 10 years.

O-RADS 2 = Almost certainly benign (<1% risk of malignancy)

Recommendation: None

O-RADS 2 = Almost certainly benign (<1% risk of malignancy)

Recommendation: Follow-up with US in 12 months*. Clinical management with gynecologist as needed.

* Shorter imaging follow-up may be considered in some scenarios (eg, clinical factors). If smaller (≥10–15% decrease in average linear dimension), no further surveillance. If stable, follow-up US at 24 months from initial exam. If enlarging (≥10–15% increase in average linear dimension), consider follow-up US at 12 and 24 months from initial exam, then management per gynecology. For changing morphology, reassess using lexicon descriptors.

O-RADS 2 = Almost certainly benign (<1% risk of malignancy)

Recommendation: Follow-up with US in 6 months*. Clinical management with gynecologist as needed.

* Shorter imaging follow-up may be considered in some scenarios (eg, clinical factors). If smaller (≥10–15% decrease in average linear dimension), no further surveillance. If stable, follow-up US at 24 months from initial exam. If enlarging (≥10–15% increase in average linear dimension), consider follow-up US at 12 and 24 months from initial exam, then management per gynecology. For changing morphology, reassess using lexicon descriptors.

O-RADS 2 = Almost certainly benign (<1% risk of malignancy)

Recommendation: Follow-up with US in 6 months*. Clinical management with gynecologist as needed.

* Shorter imaging follow-up may be considered in some scenarios (eg, clinical factors). If smaller (≥10–15% decrease in average linear dimension), no further surveillance. If stable, follow-up US at 24 months from initial exam. If enlarging (≥10–15% increase in average linear dimension), consider follow-up US at 12 and 24 months from initial exam, then management per gynecology. For changing morphology, reassess using lexicon descriptors.

O-RADS 2 = Almost certainly benign (<1% risk of malignancy)

Recommendation: Follow-up with US in 12 months*. Clinical management with gynecologist as needed.

* Shorter imaging follow-up may be considered in some scenarios (eg, clinical factors). If smaller (≥10–15% decrease in average linear dimension), no further surveillance. If stable, follow-up US at 24 months from initial exam. If enlarging (≥10–15% increase in average linear dimension), consider follow-up US at 12 and 24 months from initial exam, then management per gynecology. For changing morphology, reassess using lexicon descriptors.

O-RADS 2 = Almost certainly benign (<1% risk of malignancy)

Recommendation: Follow-up with US in 12 months*. Clinical management with gynecologist as needed.

* Shorter imaging follow-up may be considered in some scenarios (eg, clinical factors). If smaller (≥10–15% decrease in average linear dimension), no further surveillance. If stable, follow-up US at 24 months from initial exam. If enlarging (≥10–15% increase in average linear dimension), consider follow-up US at 12 and 24 months from initial exam, then management per gynecology. For changing morphology, reassess using lexicon descriptors.

O-RADS 2 = Almost certainly benign (<1% risk of malignancy)

Recommendation: None

O-RADS 2 = Almost certainly benign (<1% risk of malignancy)

Recommendation: None

O-RADS 3 = Low risk of malignancy (1-10%)

Attention:

Ascites ± peritoneal nodules not due to other malignant or non-malignant etiologies upgrades O-RADS 3 and 4 lesions to O-RADS 5. Must consider other etiologies of ascites in O-RADS categories 1 and 2.

Recommendation:

Imaging:
• If not surgically excised, consider
follow-up US within 6 months*
• If solid, may consider US specialist
(if available) or MRI (with O-RADS
MRI score)**

Clinical:
Gynecologist referral as needed

* There is a paucity of evidence for defining the optimal duration or interval for imaging surveillance. Shorter follow-up may be considered in some scenarios (eg, clinical factors). If stable, follow-up at 12 and 24 months from the initial exam, then as clinically indicated. For changing morphology, reassess using lexicon descriptors.

** MRI with contrast has a higher specificity for solid lesions, and cystic lesions with solid component(s)

O-RADS 3 = Low risk of malignancy (1-10%)

Attention:

Ascites ± peritoneal nodules not due to other malignant or non-malignant etiologies upgrades O-RADS 3 and 4 lesions to O-RADS 5. Must consider other etiologies of ascites in O-RADS categories 1 and 2.

Recommendation:

Imaging:
• If not surgically excised, consider
follow-up US within 6 months*
• If solid, may consider US specialist
(if available) or MRI (with O-RADS
MRI score)**

Clinical:
Gynecologist referral as needed

* There is a paucity of evidence for defining the optimal duration or interval for imaging surveillance. Shorter follow-up may be considered in some scenarios (eg, clinical factors). If stable, follow-up at 12 and 24 months from the initial exam, then as clinically indicated. For changing morphology, reassess using lexicon descriptors.

** MRI with contrast has a higher specificity for solid lesions, and cystic lesions with solid component(s)

O-RADS 3 = Low risk of malignancy (1-10%)

Attention:

Ascites ± peritoneal nodules not due to other malignant or non-malignant etiologies upgrades O-RADS 3 and 4 lesions to O-RADS 5. Must consider other etiologies of ascites in O-RADS categories 1 and 2.

Recommendation:

Imaging:
• If not surgically excised, consider
follow-up US within 6 months*
• If solid, may consider US specialist
(if available) or MRI (with O-RADS
MRI score)**

Clinical:
Gynecologist referral as needed

* There is a paucity of evidence for defining the optimal duration or interval for imaging surveillance. Shorter follow-up may be considered in some scenarios (eg, clinical factors). If stable, follow-up at 12 and 24 months from the initial exam, then as clinically indicated. For changing morphology, reassess using lexicon descriptors.

** MRI with contrast has a higher specificity for solid lesions, and cystic lesions with solid component(s)

O-RADS 3 = Low risk of malignancy (1-10%)

Attention:

Ascites ± peritoneal nodules not due to other malignant or non-malignant etiologies upgrades O-RADS 3 and 4 lesions to O-RADS 5. Must consider other etiologies of ascites in O-RADS categories 1 and 2.

Recommendation:

Imaging:
• If not surgically excised, consider
follow-up US within 6 months*
• If solid, may consider US specialist
(if available) or MRI (with O-RADS
MRI score)**

Clinical:
Gynecologist referral as needed

* There is a paucity of evidence for defining the optimal duration or interval for imaging surveillance. Shorter follow-up may be considered in some scenarios (eg, clinical factors). If stable, follow-up at 12 and 24 months from the initial exam, then as clinically indicated. For changing morphology, reassess using lexicon descriptors.

** MRI with contrast has a higher specificity for solid lesions, and cystic lesions with solid component(s)

O-RADS 3 = Low risk of malignancy (1-10%)

Attention:

Ascites ± peritoneal nodules not due to other malignant or non-malignant etiologies upgrades O-RADS 3 and 4 lesions to O-RADS 5. Must consider other etiologies of ascites in O-RADS categories 1 and 2.

Recommendation:

Imaging:
• If not surgically excised, consider
follow-up US within 6 months*
• If solid, may consider US specialist
(if available) or MRI (with O-RADS
MRI score)**

Clinical:
Gynecologist referral as needed

* There is a paucity of evidence for defining the optimal duration or interval for imaging surveillance. Shorter follow-up may be considered in some scenarios (eg, clinical factors). If stable, follow-up at 12 and 24 months from the initial exam, then as clinically indicated. For changing morphology, reassess using lexicon descriptors.

** MRI with contrast has a higher specificity for solid lesions, and cystic lesions with solid component(s)

O-RADS 4 = Intermediate risk of malignancy (10-50%)

Attention:

Ascites ± peritoneal nodules not due to other malignant or non-malignant etiologies upgrades O-RADS 3 and 4 lesions to O-RADS 5. Must consider other etiologies of ascites in O-RADS categories 1 and 2.

Recommendation:

Imaging:
• US specialist (if available) or
• MRI (with O–RADS MRI score)* or
• Per gyn–oncologist protocol

Clinical:
Gynecologist with gyn–oncologist consultation or solely by gyn–oncologist

* MRI with contrast has a higher specificity for solid lesions, and cystic lesions with solid component(s)

O-RADS 4 = Intermediate risk of malignancy (10-50%)

Attention:

Ascites ± peritoneal nodules not due to other malignant or non-malignant etiologies upgrades O-RADS 3 and 4 lesions to O-RADS 5. Must consider other etiologies of ascites in O-RADS categories 1 and 2.

Recommendation:

Imaging:
• US specialist (if available) or
• MRI (with O–RADS MRI score)* or
• Per gyn–oncologist protocol

Clinical:
Gynecologist with gyn–oncologist consultation or solely by gyn–oncologist

* MRI with contrast has a higher specificity for solid lesions, and cystic lesions with solid component(s)

O-RADS 5 = High risk of malignancy (≥50%)

Recommendation:

Imaging:
Per gyn-oncologist protocol

Clinical:
Gyn-oncologist

Observation:
- Location (relative to ovary):
- Size: [933]cm
- Category/Lesion type: