Objective:To evaluate the accuracy of the O-RADS system in differentiating between benign and malignant adnexal masses, as assessed by inexperienced gynecologists.Methods:Ten gynecologic residents attended a 20 h training course on the O-RADS system conducted by experienced examiners. Following the training, the residents performed ultrasound examinations on patients admitted with adnexal masses under supervision, recording the data in a database that included videos and still images. The senior author later accessed this ultrasound database and presented the cases offline to ten residents for O-RADS rating, with the raters being blinded to the final diagnosis. The efficacy of the O-RADS system by the residents and inter-observer variability were assessed.Results:A total of 201 adnexal masses meeting the inclusion criteria were evaluated, consisting of 136 (67.7%) benign masses and 65 (32.3%) malignant masses. The diagnostic performance of the O-RADS system showed a sensitivity of 90.8% (95% CI: 82.2–96.2%) and a specificity of 86.8% (95% CI: 80.4–91.8%). Inter-observer variability in scoring was analyzed using multi-rater Fleiss Kappa analysis, yielding Kappa indices of 0.642 (95% CI: 0.641–0.643). The false positive rate was primarily due to the misclassification of solid components in classic benign masses as O-RADS-4 or O-RADS-5.Conclusions:The O-RADS system demonstrates high diagnostic performance in distinguishing benign from malignant adnexal masses, even when used by inexperienced examiners. However, the false positive rate remains relatively high, mainly due to the over-interpretation of solid-appearing components in classic benign lesions. Despite this, inter-observer variability among non-expert raters was substantial. Incorporating O-RADS system training into residency programs is beneficial for inexperienced practitioners. This study could be an educational model for gynecologic residency training for other systems of sonographic features.
目的：评估缺乏经验的妇科医师应用O-RADS系统鉴别附件区肿块良恶性的准确性。方法：10名妇科住院医师接受由经验丰富的超声医师开展的为期20小时的O-RADS系统培训课程。培训结束后，住院医师在监督下对因附件区肿块入院的患者进行超声检查，将包含动态视频和静态图像的检查数据录入数据库。资深研究者随后调取该超声数据库，以离线方式向10名住院医师展示病例资料进行O-RADS分级评估，评估者对最终诊断结果不知情。研究评估了住院医师应用O-RADS系统的效能及观察者间差异性。结果：共评估符合纳入标准的201个附件区肿块，其中良性肿块136个（67.7%），恶性肿块65个（32.3%）。O-RADS系统的诊断性能显示敏感度为90.8%（95% CI：82.2–96.2%），特异度为86.8%（95% CI：80.4–91.8%）。采用多评估者Fleiss Kappa分析评估评分者间差异性，得出Kappa指数为0.642（95% CI：0.641–0.643）。假阳性率主要源于将典型良性肿块中的实性成分误判为O-RADS-4或O-RADS-5级。结论：O-RADS系统在区分附件区肿块良恶性方面展现出较高的诊断性能，即使由缺乏经验的检查者使用亦然。然而假阳性率仍相对较高，主要源于对典型良性病变中实性成分的过度解读。尽管如此，非专业评估者间的观察者差异性仍较为显著。将O-RADS系统培训纳入住院医师规范化培训项目对缺乏经验的从业者具有积极意义。本研究可为其他超声特征系统的妇科住院医师培训提供教育模式参考。
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