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Updated: Aug 24, 2026
A Coregistered Ultrasound and Photoacoustic Imaging Protocol for the Transvaginal Imaging of Ovarian Lesions
Published on: March 3, 2023
Performance of International Ovarian Tumor Analysis Simple Rules and Ovarian-Adnexal Reporting and Data System for
Rongsen Zhang1, Yusi Fu1, Xiaoye Zhang1
1Department of Ultrasound, The Second Xiangya Hospital, Central South University, No 139, Renmin Middle Road, Changsha, Hunan, 410011, P.R. China.
Background:
The International Ovarian Tumor Analysis Simple Rules (IOTA-SR) and Ovarian-Adnexal Reporting and Data System (O-RADS) are established tools for adult adnexal lesions but lack pediatric validation.
Objective:
To assess the diagnostic performance of IOTA-SR and O-RADS for malignant adnexal lesions in children.
Materials And Methods:
In this retrospective study, pediatric patients with confirmed adnexal lesions at a tertiary referral hospital between January 2015 and January 2025 were included. All lesions were classified according to O-RADS and IOTA-SR, with expert review for inconclusive cases. Diagnostic performance, including sensitivity, specificity, predictive values, accuracy, and area under the receiver operating characteristic curve (AUC), was evaluated and compared between lesion-size subgroups (≥10 cm vs. <10 cm).
Results:
A total of 431 adnexal lesions (mean diameter 7.8 cm) from 431 pediatric patients (one lesion per patient, mean age 15.0 years) were analyzed. The estimated malignancy risk in the highest-risk category was significantly greater in lesions ≥10 cm than in smaller lesions for both systems (O-RADS 5: 95.8% vs. 63.6%, P=0.026; IOTA-SR malignant classification: 95.7% vs. 66.7%, P=0.038). Overall and for lesions <10 cm, O-RADS and IOTA-SR demonstrated high and comparable diagnostic performance (overall AUC: 0.910 vs. 0.908, P=0.920; <10 cm AUC: 0.906 vs. 0.880, P=0.464). However, for lesions ≥10 cm, the AUC of O-RADS was significantly lower than that of IOTA-SR (0.835 vs. 0.921, P=0.023).
Conclusions:
Both O-RADS and IOTA-SR show acceptable diagnostic performance for pediatric adnexal lesions. IOTA-SR outperforms O-RADS in stratifying large lesions (≥10 cm) and may be preferable in such cases, while either system can be used effectively for smaller lesions.
