A rad alternative.

We’ve all read a report on a routine initial staging CT chest / abdomen / pelvis describing an adnexal mass with “pelvic ultrasound (US) recommended if clinically warranted.” You order one because you have to and then what? One-quarter of those are also indeterminate. All of a sudden, a patient with head and neck cancer is having her treatment delayed for a diagnostic oophorectomy. Not to mention the obvious fertility risk. What’s a better alternative? MRI. Enter O-RADS, the XX version of PI-RADS. In this multi-center prospective cohort study a pelvic MRI was performed for 1130 patients with indeterminate adnexal masses on US followed by surgery (two-thirds) or at least 2 years of imaging follow-up (one-third). Using the novel quantitative O-RADS scoring system of 1-5, MRI reads had 93% sensitivity and 91% specificity of recognizing a malignant etiology. TBL: Pelvic MRI with O-RADS classification may not be a bad next step after an adnexal mass is deemed “indeterminate” on pelvic ultrasound. | Thomassin-Naggara, JAMA Netw Open 2020