Interactive Transcript
0:01
Okay, so let's talk a
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little bit now about ORADs.
0:05
As we talked about very briefly in the
0:07
introduction, it can be quite overwhelming
0:09
when we're trying to determine the
0:11
risk of certain ovarian lesions.
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As we now know, there's a lot of overlap in
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ultrasound appearance, and there's quite a
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spectrum of appearances depending on patient
0:22
age and phase of the menstrual cycle as well.
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So we really need some kind of a framework to
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help us figure out what can we just let go?
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What's normal?
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Um, what's benign and doesn't need follow-up, and
0:33
then what lesions are not in those categories
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and actually might be something that we need
0:38
to revisit or might need further workup.
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So this is a really useful chart just
0:44
going through the risk stratification.
0:46
So we've got physiologic on the left,
0:49
follicles and corpus luteum cysts.
0:51
We've got our classic benign lesions
0:53
here, which we talked about briefly:
0:55
hemorrhagic cysts, dermoid
0:57
cysts, and we'll talk about those in a
0:59
little bit more detail, endometriomas.
1:00
And then there are extra-ovarian lesions,
1:04
which are quite commonly encountered:
1:06
parovarian cysts, hydrosalpinx,
1:09
and peritoneal inclusion cysts.
1:11
And we will spend a bit
1:12
more time on those as well.
1:14
And then we've got lesions that are not
1:16
classically benign, and those are broken
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down into solid and cystic components.
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So solid, as we talked about, you might
1:24
see some irregularity, some wall
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thickness. We have to look at the inner
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contour, the outer contour, whether
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there's Doppler flow, and then cystic
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lesions. Also have a variety of appearances,
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that can be unilocular or multilocular.
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They can be solid or have solid components.
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And then again, we need to look
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at the inner walls, whether there
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are some projections, etc.
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So there is quite an involved approach
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in trying to characterize these lesions.
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So it's helpful for radiologists and even for
1:55
the referring physicians, if we can put a lesion
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into a specific box that has some follow-up.
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So that really helps everybody out.
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And that is the idea behind ORADS.
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So if you do other sorts of body
2:09
imaging or breast imaging, you're
2:11
probably familiar with some of the
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other RADS reporting systems out there:
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LYRADS, PIRADS, BIRADS, etc.
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And I think that the approach to characterizing
2:22
different lesions with these reporting systems
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is here to stay and we're seeing more of
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them pop up in different parts of the body.
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So, ORADS is an ultrasound risk
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stratification and management system.
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And the goal is to really achieve some
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sort of consistency in interpretation
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and to decrease the ambiguity.
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So radiologists traditionally like to
2:45
tell stories and like to give lots of
2:47
description, but sometimes if we don't
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actually give a solid conclusion, it's really
2:53
not helpful to the referring physician.
2:56
So if we just give a description and don't
2:58
really say what we think is going on with this
3:01
lesion, it really is challenging to determine
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what, if any, other sort of follow-up or action the patient needs.
3:06
So that's the goal of ORADS.
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And this is based on a lexicon
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that was published by the ACR.
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The ORADS system recommends six
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categories, ORADS zero to five,
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and we'll go through all of those.
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And this algorithm is really to be applied
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to average-risk patients who do not have any
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acute symptoms and who do have adnexal lesions.
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And the whole ORAD system is based on a
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retrospective analysis from IOTA, which is the
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International Ovarian Tumor Analysis Group.
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They did, um, Phase one to three prospective
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studies with almost 6,000 patients.
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So it's a good chunk of
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patients that this data is based on.
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And just keep in mind that even if you use
3:54
ORADS, but you have professional judgment
3:57
on an individual case that maybe doesn't
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quite jive with ORADS, you do have the
4:03
option of modifying the ORADS recommendation
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based on your own professional judgment.
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