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O-RADS MRI score: analysis of misclassified cases in a prospective multicentric European cohort
I Thomassin-Naggara1,2, M Belghitti3,4, A Milon3,4
1APHP, Sorbonne Université, Hôpital Tenon, Service de radiologie, 58 avenue Gambetta, 75020, Paris, France. isabelle.thomassin@aphp.fr.
Objective:
To retrospectively review the causes of categorization errors using O-RADS-MRI score and to determine the presumptive causes of these misclassifications.
Methods:
EURAD database was retrospectively queried to identify misclassified lesions. In this cohort, 1194 evaluable patients with 1502 pelvic masses (277 malignant / 1225 benign lesions) underwent standardized MRI to characterize adnexal masses with histology or 2 years' follow-up as a reference standard. An expert radiologist reviewed cases with two junior radiologists and lesions termed misclassified if malignant lesion was scored ≤ 3, a benign lesion was scored ≥ 4, the site of origin was incorrect, or a non-adnexal mass was incorrectly categorized as benign or malignant.
Results:
There were 139 / 1502 (9.2%) misclassified masses in 116 women including 109 adnexal and 30 non-adnexal masses. False-negative cases corresponded to 16 borderline or invasive malignant adnexal masses rated score ≤ 3 (16 / 139, 11.5%). False-positive cases corresponded to 88 benign masses were rated score 4 (67 / 139, 48.2%) or 5 (18 / 139,12.9%) or considered suspicious non-adnexal lesions (3 / 139, 2.2%). Misclassifications were only due to origin error in 12 adnexal masses (8 benign, 4 malignant) (8.6%, 12 / 139) and 23 non-adnexal masses (18 benign, 5 malignant,16.5%, 23 / 139) perceived respectively as non-adnexal and adnexal masses. Interpretive error (n = 104), failure to recognize technical insufficient exams (n = 9), and perceptual errors (n = 4) were found. Most interpretive was due to misinterpretation of solid tissue or incorrect assignment of mass origin. Eighty-four out of 139 cases were correctly reclassified by the readers with strict adherence to the score rules.
Conclusion:
Most errors were due to misinterpretation of solid tissue or incorrect assignment of mass origin.
Key Points:
• Prospective assignment of O-RADS-MRI score resulted in misclassification of 9.25% of sonographically indeterminate pelvic masses. • Most errors were interpretive (74.8%) due to misinterpretation of solid tissue as defined by the lexicon or incorrect assignment of mass origin. • Pelvic inflammatory disease is a common source of misclassification (8.9%) (12 / 139).
Insights
O-RADS-MRI score misclassified 9.25% of pelvic masses, primarily due to interpretive errors like misinterpreting solid tissue or mass origin. Pelvic inflammatory disease was a common misclassification source.
Area of Science:
- Radiology
- Oncologic Imaging
- Pelvic MRI
Background:
- The O-RADS-MRI (Ovarian-Adnexal Reporting and Data System Magnetic Resonance Imaging) score aids in characterizing adnexal masses.
- Accurate classification is crucial for appropriate patient management and avoiding unnecessary interventions.
Purpose of the Study:
- To retrospectively analyze the causes of categorization errors using the O-RADS-MRI score.
- To identify the presumptive reasons behind misclassifications of pelvic masses.
Main Methods:
- Retrospective review of the EURAD database for misclassified pelvic masses (n=1502).
- Cases were evaluated by multiple radiologists, with misclassification defined by specific scoring, origin, or categorization criteria.
- Histology or 2-year follow-up served as the reference standard.
Main Results:
- 9.25% (139/1502) of masses were misclassified.
- Interpretive errors (74.8%) were the most common cause, stemming from misinterpreting solid tissue or incorrect mass origin assignment.
- Pelvic inflammatory disease accounted for 8.9% of misclassifications.
Conclusions:
- The O-RADS-MRI score, while valuable, is subject to misclassification, particularly due to interpretive challenges.
- Improving the understanding of solid tissue characteristics and mass origin is key to reducing errors.
- Standardized training and adherence to lexicon definitions are essential for accurate O-RADS-MRI application.
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