Interactive Transcript
0:01
So here is a breakdown of the ORADS categories.
0:04
So we've got ORADS 0, which is an
0:06
incomplete evaluation, and then ORADS 1
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is the normal physiologic ovary.
0:13
ORADS 2 is almost certainly benign,
0:16
so very low risk of malignancy.
0:18
ORADS 3 have a low risk of malignancy
0:21
between 1% to 10%, and then ORADS 4
0:24
have an intermediate risk, 10% to 50%.
0:27
And then ORADS 5 are the classic
0:30
malignant-looking lesions with a high
0:32
risk of malignancy of greater than 50%.
0:35
Okay, so we'll briefly go through
0:37
the different ORADS categories.
0:39
I won't spend a whole bunch of time on this
0:41
because you can review the document
0:43
yourself, but I just wanted to show you
0:45
in picture format what we're looking at.
0:48
So the major categories for ORADS lexicon
0:51
include physiologic group, which refers
0:55
to normal ovarian physiology and a
0:58
lesion, which is not normal physiology.
1:01
So the first step is to determine, is this a
1:04
physiologic appearance or is this a lesion?
1:08
And then we can look at the size of the lesion.
1:11
Then we look at whether there
1:12
are any solid components.
1:14
So look at the external contour, the internal
1:16
contents, the inner margin or walls, and
1:19
the vascularity, which is the color score.
1:23
On this slide, I have an image from the
1:26
article that goes through the color score.
1:29
So basically, the range is no flow, to
1:32
minimal, to moderate, to very strong flow.
1:35
And this is a little bit subjective
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because obviously minimal, moderate,
1:39
and strong are subjective features.
1:42
But I just wanted you to be aware that
1:44
that is how flow is categorized on ORADS.
1:49
And then we've got general and extra
1:51
ovarian findings, which include fluid,
1:53
ascites, and peritoneal nodules.
1:56
So ORADS 1 is a normal ovary.
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So physiologic, no likelihood
2:01
of malignancy or less than 1%.
2:03
So again, we've talked about these.
2:05
We've got a follicle, a corpus luteum
2:07
cyst, and those are pretty commonly seen.
2:09
And if you're just starting out with
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ovarian imaging, Initially when you see
2:14
a corpus luteum cyst, you might be a
2:15
little bit concerned because the wall
2:17
looks thick and there's a lot of flow
2:19
around it, and that sometimes looks scary.
2:21
But over time, more commonly, you'll see
2:23
these, and you'll be much more comfortable
2:25
calling them corpus luteum cysts.
2:28
ORADS 2 is the almost certainly benign category.
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So that is characterized by a few
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lesions, including a simple cyst.
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So those are lesions or simple cysts
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that are between 3 and 10 centimeters
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in premenopausal women and less than
2:45
10 centimeters in postmenopausal women.
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So notice that Again, that 10
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centimeter rule comes into play here.
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So even postmenopausal women can have
2:54
simple cysts that are up to 10 centimeters
2:57
in size that are not concerning for cancer.
3:00
And then we've got the classic benign
3:02
lesions like an endometrioma or a
3:05
hemorrhagic cyst or other non-simple cysts.
3:09
So here we've got a cyst that has a
3:11
partial septation or an incomplete
3:13
septa, and that's also considered benign.
3:16
ORADS 2.
3:17
And then hemorrhagic cyst, dermoid cyst, and
3:20
typical endometrioma, there's a variety of
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sonographic appearances that we see here.
3:25
And again, over time, we start to see
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these patterns and these variations,
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but we feel more comfortable with
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calling these lesions the more we see.
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So again, we've got a very typical retracting
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clot, angular margins without flow in one
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of these patients for a hemorrhagic cyst.
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The other ORADS 2 lesions are some of the
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paraovarian lesions, so that includes
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simple paraovarian cyst, peritoneal
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inclusion cyst, and hydrosalpinges.
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Those are all ORADS 2.
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ORADS 3 has a low risk of malignancy, and here
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we are a little bit more dependent on size.
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So once you get to or just above 10 centimeters,
4:09
even if it's a unilocular, simple or non-
4:12
simple cyst, that's considered ORADS 3.
4:14
Some of the typical ORADS 2 benign
4:17
lesions like hemorrhagic cyst, dermoid,
4:19
and endometrioma, again, if they're more
4:21
than 10 centimeters, that's ORADS 3.
4:24
And then as we start to get more
4:25
complex features, like an irregular
4:28
inner wall, a multilocular cyst, or a
4:31
solid component with a low amount of
4:34
flow, those are considered ORADS 3.
4:38
So I had this piece just cross my desk in the
4:42
last week, so I thought I would put it in here.
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So this is an eight centimeter cystic mass.
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So you can see that it's got several locules
4:50
in it, but the walls are really quite thin.
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So if we go back to ORADS 3 here,
4:54
this is a multilocular cyst
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with a smooth inner wall.
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It's less than 10 centimeters.
5:00
I don't have the color score in this
5:02
case because I didn't have the ultrasound
5:04
at the time of reporting, but presuming
5:06
that we have a low color score.
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In this case, this would be an ORADS 3
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just based on its size of 8 centimeters.
5:14
If this lesion was 10 centimeters
5:16
or more, this would be ORADS 4.
5:20
So now, ORADS 4 is an intermediate risk category.
5:23
So the risk of malignancy is
5:25
now between 10 and 50 percent.
5:27
And here we're getting, again, larger
5:30
lesions, more than 10 centimeters, more flow.
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So everything is kind of more: more nodules,
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more wall thickening, more blood
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flow, more solid components, etc.
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So you can see that the complexity
5:43
of the lesions is increasing as
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the ORADS risk category increases.
5:49
And then finally, ORADS 5, high risk
5:52
of malignancy of 50 percent or more.
5:54
And here, the difference between ORADS 4
5:57
and 5 is really just the number of the solid
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components, the color score, and the volume
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that's occupied by the solid component.
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And as soon as we see ascites and
6:08
peritoneal nodules again, those alarm
6:10
bells go off for a risk of malignancy.
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