@article{QIMS155002,
author = {Wenjin Lin and Qingyu Liu and Lei Xu and Xiubin Tang and Yicai Cheng and Qin Ye and Zhenhu Lin and Xiujuan Zhang},
title = {Ultrasonographic assessment of pediatric adnexal lesions: validation of the O-RADS system and development of a simplified C-CAS framework},
journal = {Quantitative Imaging in Medicine and Surgery},
volume = {16},
number = {7},
year = {2026},
keywords = {},
abstract = {Background: The Ovarian-Adnexal Reporting and Data System (O-RADS) ultrasound (US) is a standardized tool for assessing adult adnexal lesions, but its performance in the pediatric population has not been fully validated. This study aimed to validate O-RADS US in children and develop a simplified assessment framework for pediatric adnexal lesions.Methods: This retrospective study included a training cohort of 301 adnexal lesions from three centers and an independent validation cohort of 95 lesions from a fourth center. All lesions were pathologically confirmed. In the training cohort, lesions were classified according to the O-RADS V2022 criteria, and the diagnostic performance of the system was evaluated. Independent predictors of malignancy identified by firth penalized regression were used to construct a simplified framework [Cysts-Color-Ascites-Shadowing (C-CAS)]. This C-CAS framework was subsequently tested in the validation cohort.Results: Of the 396 lesions, 44 (11.11%) were malignant. In the training cohort, O-RADS showed excellent diagnostic performance [area under the curve (AUC) =0.931, 95% confidence interval (CI): 0.898–0.964]. Using a cutoff of category ≥4, sensitivity was 97.2% (95% CI: 91.9–100.0), specificity 89.1% (95% CI: 85.3–92.8%), positive predictive value 54.7% (95% CI: 42.5–66.9%), and negative predictive value 99.6% (95% CI: 98.8–100.0%). Firth regression analysis confirmed that “color score 4” [odds ratio (OR) =21.78, 95% CI: 1.80–255.38, P=0.012] and “ascites” (OR =49.13, 95% CI: 4.25–417.96, P},
issn = {2223-4306}, url = {https://qims.amegroups.org/article/view/155002}
}