Modified O-RADS Model with Septa Count and Blood Flow Improves Adnexal Lesion Risk Stratification

A modified O-RADS model subclassifying Category 4 adnexal masses by >10 locules and color score yielded a low-risk subgroup (4a) with 2.9% malignancy and a high-risk subgroup (4b) with 45.3% malignancy, achieving an AUC of 0.956.

• O-RADS 4a (139 masses) had a 2.9% (4/139) malignancy rate, while 4b (86 masses) had 45.3% (39/86), significantly higher.
• Masses with >10 locules showed a 53.3% malignancy rate; those with color score 3–4 had 38.6%.
• Decision curve analysis estimated an 18% reduction in unnecessary surgeries with the modified model.

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