Assessment of the performance of the O-RADS MRI score for the evaluation of adnexal masses, with technical notes.

Objective: To assess the performance of the Ovarian-Adnexal Reporting and Data System Magnetic Resonance Imaging (O-RADS MRI) score in the evaluation of adnexal masses and to provide technical notes about its current MRI parameters and concepts. Materials and Methods: This was a prospective study of 226 patients with 287 adnexal masses (190 submitted to surgery or biopsy and 97 followed for at least one year). We calculated the sensitivity, specificity, positive predictive value, and negative predictive value for the O-RADS MRI score, using ≥ 4 as the cutoff for malignancy. We performed a technical analysis of the main updates to the score, announced in September 2020 by the American College of Radiology, in comparison with the original (2013) version. Results: We found that an O-RADS MRI score of 4 or 5 was associated with malignancy of an adnexal mass, with a sensitivity of 91.11% (95% CI: 83.23-96.08), specificity of 94.92% (95% CI: 90.86-97.54), positive predictive value of 89.13% (95% CI: 81.71-93.77), negative predictive value of 95.90% (95% CI: 92.34-97.84), and overall accuracy of 93.73% (95% CI: 90.27-96.24). Conclusion: Our findings support the use of the O-RADS MRI score for evaluating adnexal masses, especially those considered indeterminate on ultrasound. The updates made recently to the O-RADS MRI score facilitate its interpretation and will allow its more widespread use, with no loss of diagnostic accuracy.

Objetivo: Determinar o desempenho do escore de ressonância magnética para lesões anexiais ovarianas (escore O-RADS RM), com notas técnicas sobre seus atuais parâmetros e conceitos de RM utilizados. Materiais e Métodos: Este estudo incluiu 226 pacientes com 287 massas anexiais (190 pacientes submetidas a cirurgia/biópsia e 97 pacientes com pelo menos um ano de seguimento). Calculamos sensibilidade, especificidade, valores preditivos positivos e negativos para as categorias do escore O-RADS RM, usando ≥ 4 como ponto de corte para malignidade. Realizamos análise técnica das principais atualizações do escore, anunciadas em setembro de 2020 pelo American College of Radiology, em comparação com a versão original de 2013. Resultados: Escores O-RADS RM categorias 4 ou 5 foram associados com malignidade da massa anexial, com sensibilidade de 91,11% (IC 95%: 83,23-96,08), especificidade de 94,92% (IC 95%: 90,86-97,54), valor preditivo positivo de 89,13% (IC 95%: 81,71-93,77), valor preditivo negativo de 95,90% (IC 95%: 92,34-97,84) e acurácia de 93,73% (IC 95%: 90,27-96,24). Conclusão: Este estudo reforçou o uso do escore O-RADS RM para avaliar massas anexiais, principalmente as indeterminadas por ultrassom. As atualizações feitas recentemente no escore O-RADS RM facilitam sua interpretação e permitirão seu uso mais difundido, sem perder a precisão diagnóstica.

Assessment of the performance of the O-RADS MRI score for the evaluation of adnexal masses, with technical notes / Desempenho do escore O-RADS RM para avaliação de massas anexiais, com notas técnicas

Abstract Objective: To assess the performance of the Ovarian-Adnexal Reporting and Data System Magnetic Resonance Imaging (O-RADS MRI) score in the evaluation of adnexal masses and to provide technical notes about its current MRI parameters and concepts. Materials and Methods: This was a prospective study of 226 patients with 287 adnexal masses (190 submitted to surgery or biopsy and 97 followed for at least one year). We calculated the sensitivity, specificity, positive predictive value, and negative predictive value for the O-RADS MRI score, using ≥ 4 as the cutoff for malignancy. We performed a technical analysis of the main updates to the score, announced in September 2020 by the American College of Radiology, in comparison with the original (2013) version. Results: We found that an O-RADS MRI score of 4 or 5 was associated with malignancy of an adnexal mass, with a sensitivity of 91.11% (95% CI: 83.23-96.08), specificity of 94.92% (95% CI: 90.86-97.54), positive predictive value of 89.13% (95% CI: 81.71-93.77), negative predictive value of 95.90% (95% CI: 92.34-97.84), and overall accuracy of 93.73% (95% CI: 90.27-96.24). Conclusion: Our findings support the use of the O-RADS MRI score for evaluating adnexal masses, especially those considered indeterminate on ultrasound. The updates made recently to the O-RADS MRI score facilitate its interpretation and will allow its more widespread use, with no loss of diagnostic accuracy.

Resumo Objetivo: Determinar o desempenho do escore de ressonância magnética para lesões anexiais ovarianas (escore O-RADS RM), com notas técnicas sobre seus atuais parâmetros e conceitos de RM utilizados. Materiais e Métodos: Este estudo incluiu 226 pacientes com 287 massas anexiais (190 pacientes submetidas a cirurgia/biópsia e 97 pacientes com pelo menos um ano de seguimento). Calculamos sensibilidade, especificidade, valores preditivos positivos e negativos para as categorias do escore O-RADS RM, usando ≥ 4 como ponto de corte para malignidade. Realizamos análise técnica das principais atualizações do escore, anunciadas em setembro de 2020 pelo American College of Radiology, em comparação com a versão original de 2013. Resultados: Escores O-RADS RM categorias 4 ou 5 foram associados com malignidade da massa anexial, com sensibilidade de 91,11% (IC 95%: 83,23-96,08), especificidade de 94,92% (IC 95%: 90,86-97,54), valor preditivo positivo de 89,13% (IC 95%: 81,71-93,77), valor preditivo negativo de 95,90% (IC 95%: 92,34-97,84) e acurácia de 93,73% (IC 95%: 90,27-96,24). Conclusão: Este estudo reforçou o uso do escore O-RADS RM para avaliar massas anexiais, principalmente as indeterminadas por ultrassom. As atualizações feitas recentemente no escore O-RADS RM facilitam sua interpretação e permitirão seu uso mais difundido, sem perder a precisão diagnóstica.

Improving the performance of IOTA simple rules: sonographic assessment of adnexal masses with resource-effective use of a magnetic resonance scoring (ADNEX MR scoring system).

PURPOSE: To compare the International Ovarian Tumor Analysis (IOTA) simple rules, simple rules risk ultrasound models, alone or in combination with magnetic resonance (MR) score to predict malignancy in women with adnexal masses. METHODS: 171 women with adnexal masses were included from February 2014 to February 2016. 120 women had histopathological diagnosis obtained from surgery or percutaneous biopsy. The other 51 women were submitted to surveillance with ultrasound (US) for at least 1 year. Patients were examined with US and MR. US reports were rendered using IOTA systems. We compared five diagnostic approaches, aimed at diagnosing women with malignant tumors among those with adnexal masses: We calculated the performance and net benefits (decision curve analysis) for five distinct diagnostic approaches: (1) US simple rules (SR), (2) simple rules risk score (SRRisk), (3) US SR followed by subjective assessment (SA) of indeterminate cases, (4) SR followed by MR score for the indeterminate cases, and (5) MR score for all women. RESULTS: The MR score for all patients was the approach that yielded the best-standardized net benefit regardless of the risk threshold. However, referring women with indeterminate masses on SR to MR score yielded the second-best net benefit. CONCLUSION: Although this study leaves no doubt about the superiority of MR score over US-based methods for the discrimination of malignant tumors in women with adnexal masses, restricting the use of MR score only to women with indeterminate masses on US SR is a safe, appropriate way to triage women with adnexal masses.

Systemic granulomatous diseases associated with multiple palpable masses that may involve the breast: case presentation and an approach to the differential diagnosis.

Palpable mass is a common complaint presented to the breast surgeon. It is very uncommon for patients to report breast mass associated with palpable masses in other superficial structures. When these masses are related to systemic granulomatous diseases, the diagnosis and initiation of specific therapy can be challenging. The purpose of this paper is to report a case initially assessed by the breast surgeon and ultimately diagnosed as granulomatous variant of T-cell lymphoma, and discuss the main systemic granulomatous diseases associated with palpable masses involving the breast.

Case report and review of the literature: secretory breast cancer in a 13-year-old boy--10 years of follow up.

Carcinoma of the breast is very rare in childhood, accounting for less than 1% of all childhood malignancies and is especially rare in boys. Delay in diagnosis and treatment in children with breast cancer may occur because surgeons are very reluctant to perform biopsies on the developing breast, since these can cause future deformity. We report a case of male secretory breast carcinoma in a 13-year-old boy. Radical mastectomy was performed followed by chemotherapy. The patient is free of disease after 10 years. Secretory breast carcinoma (SBC) is the commonest type of breast carcinoma in children. In this article, we discuss the diagnosis and treatment options for breast cancer among children as well as features of SBC, based on a literature review.