Normal ovary / definitively benign physiologic finding (e.g., a normal premenopausal ovary, including follicles and corpus luteum); no discrete lesion meeting higher-category descriptors.
CondutaNo lesion-specific imaging follow-up is necessary for a normal ovary or definitively benign physiologic finding; subsequent care follows the clinical context.
Almost certainly benign lesion: classic benign appearances such as a simple cyst, classic hemorrhagic cyst, classic dermoid (mature cystic teratoma), classic endometrioma, para-ovarian cyst, peritoneal inclusion cyst, or hydrosalpinx; also unilocular cysts up to about 10 cm with smooth inner walls and no solid component.
CondutaFor lesions with classic benign ultrasound features, no further evaluation is generally required on identification; certain subtypes warrant short-interval follow-up ultrasound (e.g., larger hemorrhagic cysts and endometriomas) as described in the source.
RiscoAlmost certainly benign, with less than 1% risk of malignancy.
Low-risk lesion: e.g., a unilocular cyst 10 cm or larger with smooth inner wall, a multilocular cyst smaller than 10 cm with smooth inner wall and color score 1-3, a unilocular cyst with an irregular inner wall (less than 3 mm), or a smooth-contoured solid lesion of any size with color score 1.
CondutaFurther characterization by management with an ultrasound specialist or by MRI (the two considered equivalent for O-RADS 3) is recommended; MRI is particularly valuable in postmenopausal patients.
RiscoLow risk, 1% to less than 10% risk of malignancy (stated as 1-9% in the corroborating source).
Intermediate-risk lesion: e.g., multilocular cyst 10 cm or larger (or any size with color score 4), multilocular cyst with irregular wall/septation, unilocular cyst with a solid component and 0-3 papillary projections (any color score), multilocular cyst with a solid component and color score 1-2, or a smooth-contoured solid lesion with color score 2-3.
CondutaConsultation with a gynecologic oncologist is recommended; further characterization by MRI (or an ultrasound specialist, considered equivalent to MRI for O-RADS 3-4) may be used.
RiscoIntermediate risk, 10% to less than 50% risk of malignancy.
High-risk lesion: e.g., unilocular cyst with 4 or more papillary projections (any color score), multilocular cyst with a solid component and color score 3-4, smooth-contoured solid lesion with color score 4, any solid lesion with irregular outer contour (any color score), or any O-RADS 3-5 lesion accompanied by ascites and/or peritoneal nodules.
CondutaDirect referral to a gynecologic oncologist is recommended.
RiscoHigh risk, 50% or greater risk of malignancy.