Age-stratified diagnostic performance of the ovarian-adnexal reporting and data system for adnexal masses: a focus on school-age children, early, and middle adolescents.
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OBJECTIVE: To evaluate the age-stratified diagnostic performance of the Ovarian-Adnexal Reporting and Data System (O-RADS) for distinguishing malignant adnexal masses in school-age children, early adolescents, and middle adolescents. METHODS: This retrospective study included 501 pediatric patients with adnexal masses. All masses were classified according to the O-RADS ultrasound lexicon. Diagnostic performance was assessed across three age groups: school-age children, early adolescents, and middle adolescents. RESULTS: Among 501 masses, 72 were in school-age children, 163 in early adolescents, and 266 in middle adolescents. In school-age children, sensitivity and negative predictive value (NPV) were both 100.0%, specificity 93.6%, and area under the curve (AUC) 0.968; in early adolescents, sensitivity 95.8%, specificity 88.5%, and AUC 0.922; in middle adolescents, sensitivity decreased to 88.2%, specificity to 85.6%, and AUC to 0.869. Positive predictive value (PPV) declined from 71.4% in school-age children to 29.4% in middle adolescents. A significant difference in AUC was observed between middle adolescents and school-age children (P = 0.027). CONCLUSION: The O-RADS ultrasound demonstrated favorable diagnostic performance in school-age children and early adolescents. The declining performance in middle adolescents, particularly the marked drop in PPV and significant decrease in AUC, underscores the need for age-specific considerations when applying O-RADS in pediatric populations.