Improving risk stratification of indeterminate adnexal masses on MRI: What imaging features help predict malignancy in O-RADS MRI 4 lesions? Journal Article

   

Authors:	Wong, B. Z. Y.; Causa Andrieu, P. I.; Sonoda, Y.; Chi, D. S.; Aviki, E. M.; Vargas, H. A.; Woo, S.
Article Title:	Improving risk stratification of indeterminate adnexal masses on MRI: What imaging features help predict malignancy in O-RADS MRI 4 lesions?
Abstract:	Purpose: Ovarian-Adnexal Reporting and Data System (O-RADS) MRI uses a 5-point scale to establish malignancy risk in sonographically-indeterminate adnexal masses. The management of O-RADS MRI score 4 lesions is challenging, as the prevalence of malignancy is widely variable (5–90%). We assessed imaging features that may sub-stratify O-RADS MRI 4 lesions into malignant and benign subgroups. Method: Retrospective single-institution study of women with O-RADS MRI score of 4 adnexal masses between April 2021–August 2022. Imaging findings were assessed independently by 2 radiologists according to the O-RADS lexicon white paper. MRI and clinical findings were compared between malignant and benign adnexal masses, and inter-reader agreement was calculated. Results: Seventy-four women (median age 52 years, IQR 36–61) were included. On pathology, 41 (55.4%) adnexal masses were malignant. Patients with malignant masses were younger (p = 0.02) with higher CA-125 levels (p = 0.03). Size of solid tissue was greater in malignant masses (p = 0.01–0.04). Papillary projections and larger solid portion were more common in malignant lesions; irregular septations and predominantly solid composition were more frequent in benign lesions (p < 0.01). Solid tissue of malignant lesions was more often hyperintense on T2-weighted and diffusion-weighted imaging (p ≤ 0.03). Other imaging findings were not significantly different (p = 0.09–0.77). Inter-reader agreement was excellent–good for most features (ICC = 0. 662–0.950; k = 0. 650–0.860). Conclusion: Various MRI and clinical features differed between malignant and benign O-RADS MRI score 4 adnexal masses. O-RADS MRI 4 lesions may be sub-stratified (high vs low risk) based on solid tissue characteristics and CA-125 levels. © 2023 Elsevier B.V.
Keywords:	adult; controlled study; human tissue; middle aged; major clinical study; clinical feature; histopathology; cancer risk; solid tumor; cancer patient; nuclear magnetic resonance imaging; endometrioid carcinoma; cancer grading; metastasis; tumor volume; cystadenoma; cohort analysis; retrospective study; risk assessment; ovary; radiologist; scoring system; granulosa cell tumor; prediction and forecasting; fibroma; malignancy; papilloma; ca 125 antigen; diffusion weighted imaging; struma ovarii; thyroid papillary carcinoma; mri; endometriosis; adenofibroma; leiomyoma; apparent diffusion coefficient; adnexa disease; benign neoplasm; adnexal mass; androblastoma; human; female; article; smooth muscle tumor of uncertain malignant potential; borderline state; serous cystadenoma; malignant neoplasm; benign mesothelioma; gynecologic imaging reporting and data system; t2 weighted imaging; t1 weighted imaging; o-rads; adnexal cancer (gynecologic); cystadenofibroma; feature detection; ovarian fibrothecoma
Journal Title:	European Journal of Radiology
Volume:	168
ISSN:	0720-048X
Publisher:	Elsevier B.V
Date Published:	2023-11-01
Start Page:	111122
Language:	English
DOI:	10.1016/j.ejrad.2023.111122
PUBMED:	37806193
PROVIDER:	scopus
PMCID:	PMC11186047
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85173485036&doi=10.1016%2fj.ejrad.2023.111122&partnerID=40&md5=452fb38d78505eba9f878f1be7000006
Notes:	The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF. Corresponding MSK author is Sungmin Woo -- Source: Scopus

https://synapse.mskcc.org/synapse/works/has_related_data_chk/210512