Analysis of the efficacy of adnexal mass diagnosis by senior and junior sonologists based on subjective diagnosis and O-RADS classification

In clinical practice, the majority of adnexal masses(AMs) are assessed and diagnosed by junior ultrasonologists, as there are more primary ultrasonologists than specialists. However, diagnostic omissions and misdiagnoses are common due to the inexperience of junior ultrasonologists, and diagnostic accuracy varies significantly among different individuals and research centres. Therefore, a more reliable assessment of the malignancy risk of adnexal lesions is necessary to aid sonologists, particularly those who lack experience, in diagnosing AMs.The purposes of this study were to compare the effectiveness of benign and malignant adnexal mass diagnosis based on subjective assessments and the O-RADS US among sonologists with different experience levels and evaluate consistency; furthermore, to analyse the reasons for missed and misdiagnosed cases and inconsistent O-RADS classification to promote the practical application and promotion of O-RADS ultrasound classification in clinical settings. A senior and a junior sonologist subjectively evaluated and O-RADS classified adnexal masses using the blind method, both of them had participated in the systematic learning and training of O-RADS diagnostic guidelines. With postoperative pathological results as the gold standard, the receiver operating characteristic curve was used to test the diagnostic performance. Kappa (k) statistics were used to assess the interobserver agreement. Of the 530 adnexal lesions, 470 (88.7%) were benign and 60 (11.3%) were malignant. The area under the curve of O-RADS classification and subjective judgment were 0.94 (95% CI: 0.92–0.96) and 0.79 (95%CI: 0.73–0.84) for the junior sonologist (P < 0.05) and 0.96 (95% CI: 0.94–0.97) and 0.93 (95% CI: 0.88–0.98) for the senior sonologist (P < 0.05). The interobserver agreement was poor in subjective judgment (Kappa value was 0.34, P < 0.05). The Kappa value of O-RADS classification was 0.91( P < 0.05). For both the senior and junior sonologists, the diagnostic efficacy and consistency using the O-RADS were better than those of their subjective diagnoses. When the junior sonologist utilized the O-RADS, diagnostic efficacy was significantly improved.