O-RADS Decision Tree - Complete Path Reference This document lists every possible path through the O-RADS decision tree application, along with the resulting O-RADS score and management recommendations.
Table of Contents Quick Reference: O-RADS Score Summary
Path 1: Normal Ovary / Physiologic Cyst
Path 2: Incomplete Study
Path 3: Simple Cyst (Branch A)
Path 4: Classic Benign Lesions (Branch B)
Path 5: Cystic Lesion Non-Classic (Branch C)
Path 6: Solid Mass (Branch D)
Path 7: Ascites / Peritoneal Nodules
Quick Reference: O-RADS Score Summary Score Category Risk Color 0 Incomplete Evaluation N/A ⬜ Gray 1 Normal Ovary N/A 🟢 Green 2 Almost Certainly Benign <1% 🟢 Light Green 3 Low Risk 1–<10% 🟡 Yellow 4 Intermediate Risk 10–<50% 🟠 Orange 5 High Risk ≥50% 🔴 Red
Path 1: Normal Ovary / Physiologic Cyst Clicks: 1
Result: O-RADS 1 Field Value Score 1 Category Normal Ovary Risk N/A Description No ovarian lesion; physiologic cyst (follicle ≤3cm or corpus luteum) Management None required Imaging Follow-up None Clinical Follow-up None IMPRESSION No ovarian lesion; physiologic cyst (follicle ≤3cm or corpus luteum) (O-RADS 1): No further imaging follow-up.
Path 2: Incomplete Study Clicks: 1
Result: O-RADS 0 Field Value Score 0 Category Incomplete Evaluation Risk N/A Description Lesion features cannot be accurately characterized due to technical factors Management Repeat US study or MRI Imaging Follow-up Repeat ultrasound study or consider MRI Clinical Follow-up As clinically indicated IMPRESSION Lesion features cannot be accurately characterized due to technical factors (O-RADS 0): Repeat ultrasound study or consider MRI
Path 3: Simple Cyst (Branch A) Path 3.1: Simple Cyst ≤3 cm, Premenopausal Clicks: 3
Result: O-RADS 1 Field Value Score 1 Category Physiologic - Follicle Risk N/A Description Simple cyst ≤3cm in premenopausal patient (follicle) Management None required Imaging Follow-up None Clinical Follow-up None IMPRESSION Simple cyst ≤3cm in premenopausal patient (follicle) (O-RADS 1): No further imaging follow-up.
Path 3.2: Simple Cyst ≤3 cm, Postmenopausal Clicks: 3
Result: O-RADS 2 Field Value Score 2 Category Almost Certainly Benign Risk <1% Description Simple cyst ≤3cm in postmenopausal patient Management Routine follow-up Imaging Follow-up None Clinical Follow-up None IMPRESSION Simple cyst ≤3cm in postmenopausal patient (O-RADS 2): No further imaging follow-up.
Path 3.3: Simple Cyst >3 cm to 5 cm, Premenopausal Clicks: 3
Result: O-RADS 2 Field Value Score 2 Category Almost Certainly Benign Risk <1% Description Simple cyst >3cm to 5cm Management Imaging surveillance if postmenopausal Imaging Follow-up None Clinical Follow-up None IMPRESSION Simple cyst >3cm to 5cm (O-RADS 2): No further imaging follow-up.
Path 3.4: Simple Cyst >3 cm to 5 cm, Postmenopausal Clicks: 3
Result: O-RADS 2 Field Value Score 2 Category Almost Certainly Benign Risk <1% Description Simple cyst >3cm to 5cm Management Imaging surveillance if postmenopausal Imaging Follow-up Follow-up US in 12 months Clinical Follow-up None IMPRESSION Simple cyst >3cm to 5cm (O-RADS 2): Follow-up US in 12 months
Path 3.5: Simple Cyst >5 cm but <10 cm Clicks: 2
Result: O-RADS 2 Field Value Score 2 Category Almost Certainly Benign Risk <1% Description Simple cyst >5cm but <10cm Management Imaging surveillance Imaging Follow-up Follow-up US in 12 months Clinical Follow-up As clinically indicated IMPRESSION Simple cyst >5cm but <10cm (O-RADS 2): Follow-up US in 12 months
Path 3.6: Simple Cyst ≥10 cm Clicks: 2
Result: O-RADS 3 Field Value Score 3 Category Low Risk Risk 1–<10% Description Simple cyst ≥10cm Management Gynecologist consultation; consider follow-up imaging Imaging Follow-up Consider follow-up US within 6 months if not surgically excised Clinical Follow-up Gynecologist IMPRESSION Simple cyst ≥10cm (O-RADS 3): Consider follow-up US within 6 months if not surgically excised
Path 4: Classic Benign Lesions (Branch B) Path 4.1: Hemorrhagic Cyst Path 4.1.1: Hemorrhagic Cyst, Premenopausal, ≤5 cm Clicks: 4
Result: O-RADS 2 Field Value Score 2 Category Typical Hemorrhagic Cyst Risk <1% Description Hemorrhagic cyst ≤5cm, premenopausal Management None required Imaging Follow-up None Clinical Follow-up Gynecologist as needed IMPRESSION Hemorrhagic cyst ≤5cm, premenopausal (O-RADS 2): No further imaging follow-up.
Path 4.1.2: Hemorrhagic Cyst, Premenopausal, >5 cm but <10 cm Clicks: 4
Result: O-RADS 2 Field Value Score 2 Category Typical Hemorrhagic Cyst Risk <1% Description Hemorrhagic cyst >5cm but <10cm, premenopausal Management Short-term follow-up to confirm resolution Imaging Follow-up Follow-up US in 2-3 months Clinical Follow-up Gynecologist as needed IMPRESSION Hemorrhagic cyst >5cm but <10cm, premenopausal (O-RADS 2): Follow-up US in 2-3 months
Path 4.1.3: Hemorrhagic Cyst, Premenopausal, ≥10 cm Clicks: 4
Result: O-RADS 3 Field Value Score 3 Category Typical Hemorrhagic Cyst (Large) Risk 1–<10% Description Hemorrhagic cyst ≥10cm Management Gynecologist consultation Imaging Follow-up Follow-up US within 6 months if not excised Clinical Follow-up Gynecologist IMPRESSION Hemorrhagic cyst ≥10cm (O-RADS 3): Follow-up US within 6 months if not excised
Path 4.1.4: Hemorrhagic Cyst, Early Postmenopausal Clicks: 3
Result: O-RADS 2 Field Value Score 2 Category Typical Hemorrhagic Cyst Risk <1% Description Hemorrhagic cyst <10cm, early postmenopausal Management Confirm diagnosis; may need additional imaging Imaging Follow-up Follow-up US in 2-3 months, or US specialist, or MRI Clinical Follow-up Gynecologist as needed IMPRESSION Hemorrhagic cyst <10cm, early postmenopausal (O-RADS 2): Follow-up US in 2-3 months, or US specialist, or MRI
Path 4.1.5: Hemorrhagic Cyst, Late Postmenopausal Clicks: 3
Result: O-RADS 3 Field Value Score 3 Category Atypical - Recategorize Risk 1–<10% Description Should not occur in late postmenopausal; recategorize using other lexicon descriptors Management Recategorize lesion using cystic lesion descriptors Imaging Follow-up Reassess with other lexicon descriptors Clinical Follow-up Gynecologist consultation recommended IMPRESSION Should not occur in late postmenopausal; recategorize using other lexicon descriptors (O-RADS 3): Reassess with other lexicon descriptors
Path 4.2: Dermoid Cyst Path 4.2.1: Dermoid Cyst ≤3 cm Clicks: 3
Result: O-RADS 2 Field Value Score 2 Category Typical Dermoid Cyst Risk <1% Description Dermoid cyst ≤3cm Management May consider surveillance Imaging Follow-up May consider follow-up US in 12 months Clinical Follow-up Gynecologist as needed IMPRESSION Dermoid cyst ≤3cm (O-RADS 2): May consider follow-up US in 12 months
Path 4.2.2: Dermoid Cyst >3 cm but <10 cm Clicks: 3
Result: O-RADS 2 Field Value Score 2 Category Typical Dermoid Cyst Risk <1% Description Dermoid cyst >3cm but <10cm Management Surveillance or surgical excision Imaging Follow-up Follow-up US in 12 months if not surgically excised Clinical Follow-up Gynecologist as needed IMPRESSION Dermoid cyst >3cm but <10cm (O-RADS 2): Follow-up US in 12 months if not surgically excised
Path 4.2.3: Dermoid Cyst ≥10 cm Clicks: 3
Result: O-RADS 3 Field Value Score 3 Category Typical Dermoid Cyst Risk 1–<10% Description Dermoid cyst ≥10cm Management Gynecologist consultation; consider surgery or close follow-up Imaging Follow-up Consider follow-up US within 6 months if not excised Clinical Follow-up Gynecologist IMPRESSION Dermoid cyst ≥10cm (O-RADS 3): Consider follow-up US within 6 months if not excised
Path 4.3: Endometrioma Path 4.3.1: Endometrioma <10 cm, Premenopausal Clicks: 4
Result: O-RADS 2 Field Value Score 2 Category Typical Endometrioma Risk <1% Description Endometrioma <10cm, premenopausal Management Surveillance or surgical excision Imaging Follow-up Follow-up US in 12 months if not surgically excised Clinical Follow-up Gynecologist as needed IMPRESSION Endometrioma <10cm, premenopausal (O-RADS 2): Follow-up US in 12 months if not surgically excised
Path 4.3.2: Endometrioma <10 cm, Postmenopausal Clicks: 4
Result: O-RADS 2 Field Value Score 2 Category Typical Endometrioma Risk <1% Description Endometrioma <10cm, postmenopausal (initial) Management Confirm diagnosis, then surveillance Imaging Follow-up Follow-up US in 2-3 months (or specialist/MRI), then 12 months if not excised Clinical Follow-up Gynecologist as needed IMPRESSION Endometrioma <10cm, postmenopausal (initial) (O-RADS 2): Follow-up US in 2-3 months (or specialist/MRI), then 12 months if not excised
Path 4.3.3: Endometrioma ≥10 cm Clicks: 3
Result: O-RADS 3 Field Value Score 3 Category Typical Endometrioma Risk 1–<10% Description Endometrioma ≥10cm Management Gynecologist consultation; consider surgery Imaging Follow-up Consider follow-up US within 6 months if not excised Clinical Follow-up Gynecologist IMPRESSION Endometrioma ≥10cm (O-RADS 3): Consider follow-up US within 6 months if not excised
Path 4.4: Paraovarian Cyst Clicks: 2
Result: O-RADS 2 Field Value Score 2 Category Typical Paraovarian Cyst Risk <1% Description Simple cyst separate from the ovary Management None required (extraovarian) Imaging Follow-up None Clinical Follow-up Gynecologist as needed IMPRESSION Simple cyst separate from the ovary (O-RADS 2): No further imaging follow-up.
Path 4.5: Peritoneal Inclusion Cyst Clicks: 2
Result: O-RADS 2 Field Value Score 2 Category Typical Peritoneal Inclusion Cyst Risk <1% Description Fluid collection with ovary at margin or suspended within, conforming to adjacent organs Management None required (extraovarian) Imaging Follow-up None Clinical Follow-up Gynecologist as needed IMPRESSION Fluid collection with ovary at margin or suspended within, conforming to adjacent organs (O-RADS 2): No further imaging follow-up.
Path 4.6: Hydrosalpinx Clicks: 2
Result: O-RADS 2 Field Value Score 2 Category Typical Hydrosalpinx Risk <1% Description Anechoic, fluid-filled tubular structure (extraovarian) Management None required (extraovarian) Imaging Follow-up None Clinical Follow-up Gynecologist as needed IMPRESSION Anechoic, fluid-filled tubular structure (extraovarian) (O-RADS 2): No further imaging follow-up.
Path 5: Cystic Lesion Non-Classic (Branch C) Path 5.1: With Solid Component(s) Path 5.1.1: Unilocular with Solid, <4 Papillary Projections Clicks: 4
Result: O-RADS 4 Field Value Score 4 Category Intermediate Risk - Solid Component Risk 10–<50% Description Unilocular cyst with <4 papillary projections or non-pp solid component Management US specialist, MRI, or per gyn-oncologist protocol Imaging Follow-up Options: US specialist, MRI with O-RADS MRI score, or per gyn-oncologist Clinical Follow-up Gynecologist with gyn-oncologist consultation IMPRESSION Unilocular cyst with <4 papillary projections or non-pp solid component (O-RADS 4): Options: US specialist, MRI with O-RADS MRI score, or per gyn-oncologist
Path 5.1.2: Unilocular with Solid, ≥4 Papillary Projections Clicks: 4
Result: O-RADS 5 Field Value Score 5 Category High Risk - Multiple Papillary Projections Risk ≥50% Description Unilocular cyst with ≥4 papillary projections Management Refer to gynecologic oncologist Imaging Follow-up Per gyn-oncologist protocol Clinical Follow-up Gyn-oncologist IMPRESSION Unilocular cyst with ≥4 papillary projections (O-RADS 5): Per gyn-oncologist protocol
Path 5.1.3: Bi/Multilocular with Solid, CS 1-2 Clicks: 4
Result: O-RADS 4 Field Value Score 4 Category Intermediate Risk - Solid Component Risk 10–<50% Description Bilocular cyst with solid component(s), CS 1-2 Management US specialist, MRI, or per gyn-oncologist protocol Imaging Follow-up Options: US specialist, MRI with O-RADS MRI score, or per gyn-oncologist Clinical Follow-up Gynecologist with gyn-oncologist consultation IMPRESSION Bilocular cyst with solid component(s), CS 1-2 (O-RADS 4): Options: US specialist, MRI with O-RADS MRI score, or per gyn-oncologist
Path 5.1.4: Bi/Multilocular with Solid, CS 3-4 Clicks: 4
Result: O-RADS 5 Field Value Score 5 Category High Risk - Vascular Solid Component Risk ≥50% Description Bilocular cyst with solid component(s) and CS 3 Management Refer to gynecologic oncologist Imaging Follow-up Per gyn-oncologist protocol Clinical Follow-up Gyn-oncologist IMPRESSION Bilocular cyst with solid component(s) and CS 3 (O-RADS 5): Per gyn-oncologist protocol
Path 5.2: Without Solid Component - Unilocular Path 5.2.1: Unilocular, Smooth, <10 cm Clicks: 5
Result: O-RADS 2 Field Value Score 2 Category Almost Certainly Benign Risk <1% Description Unilocular smooth non-simple cyst <10cm Management Surveillance based on size Imaging Follow-up Follow-up US in 6-12 months based on size Clinical Follow-up None IMPRESSION Unilocular smooth non-simple cyst <10cm (O-RADS 2): Follow-up US in 6-12 months based on size
Path 5.2.2: Unilocular, Smooth, ≥10 cm Clicks: 5
Result: O-RADS 3 Field Value Score 3 Category Low Risk - Large Unilocular Risk 1–<10% Description Unilocular smooth cyst ≥10cm Management Gynecologist consultation Imaging Follow-up Consider follow-up US within 6 months if not excised Clinical Follow-up Gynecologist IMPRESSION Unilocular smooth cyst ≥10cm (O-RADS 3): Consider follow-up US within 6 months if not excised
Path 5.2.3: Unilocular, Irregular Clicks: 4
Result: O-RADS 3 Field Value Score 3 Category Low Risk - Irregular Unilocular Risk 1–<10% Description Unilocular cyst with irregular inner wall (no solid component) Management Consider US specialist or MRI; Gynecologist consultation Imaging Follow-up Consider follow-up US within 6 months if not excised Clinical Follow-up Gynecologist IMPRESSION Unilocular cyst with irregular inner wall (no solid component) (O-RADS 3): Consider follow-up US within 6 months if not excised
Path 5.3: Without Solid Component - Bilocular Path 5.3.1: Bilocular, Smooth, <10 cm Clicks: 5
Result: O-RADS 2 Field Value Score 2 Category Almost Certainly Benign Risk <1% Description Bilocular smooth cyst <10cm Management Surveillance Imaging Follow-up Follow-up US in 6 months Clinical Follow-up None IMPRESSION Bilocular smooth cyst <10cm (O-RADS 2): Follow-up US in 6 months
Path 5.3.2: Bilocular, Smooth, ≥10 cm Clicks: 5
Result: O-RADS 3 Field Value Score 3 Category Low Risk - Large Bilocular Risk 1–<10% Description Bilocular smooth cyst ≥10cm Management Gynecologist consultation Imaging Follow-up Consider follow-up US within 6 months if not excised Clinical Follow-up Gynecologist IMPRESSION Bilocular smooth cyst ≥10cm (O-RADS 3): Consider follow-up US within 6 months if not excised
Path 5.3.3: Bilocular, Irregular Clicks: 4
Result: O-RADS 4 Field Value Score 4 Category Intermediate Risk - Irregular Bilocular Risk 10–<50% Description Bilocular cyst with irregular inner wall/septation Management US specialist, MRI, or per gyn-oncologist protocol Imaging Follow-up Options: US specialist, MRI with O-RADS MRI score, or per gyn-oncologist Clinical Follow-up Gynecologist with gyn-oncologist consultation IMPRESSION Bilocular cyst with irregular inner wall/septation (O-RADS 4): Options: US specialist, MRI with O-RADS MRI score, or per gyn-oncologist
Path 5.4: Without Solid Component - Multilocular Path 5.4.1: Multilocular, Smooth, <10 cm, CS <4 Clicks: 5
Result: O-RADS 3 Field Value Score 3 Category Low Risk - Multilocular Risk 1–<10% Description Multilocular smooth cyst <10cm, CS <4 Management Gynecologist consultation Imaging Follow-up Consider follow-up US within 6 months if not excised Clinical Follow-up Gynecologist IMPRESSION Multilocular smooth cyst <10cm, CS <4 (O-RADS 3): Consider follow-up US within 6 months if not excised
Path 5.4.2: Multilocular, Smooth, ≥10 cm, CS <4 Clicks: 5
Result: O-RADS 4 Field Value Score 4 Category Intermediate Risk - Large Multilocular Risk 10–<50% Description Multilocular smooth cyst ≥10cm, CS <4 Management US specialist, MRI, or per gyn-oncologist protocol Imaging Follow-up Options: US specialist, MRI with O-RADS MRI score, or per gyn-oncologist Clinical Follow-up Gynecologist with gyn-oncologist consultation IMPRESSION Multilocular smooth cyst ≥10cm, CS <4 (O-RADS 4): Options: US specialist, MRI with O-RADS MRI score, or per gyn-oncologist
Path 5.4.3: Multilocular, Smooth, Any Size, CS 4 Clicks: 5
Result: O-RADS 4 Field Value Score 4 Category Intermediate Risk - Highly Vascular Multilocular Risk 10–<50% Description Multilocular smooth cyst with CS 4 Management US specialist, MRI, or per gyn-oncologist protocol Imaging Follow-up Options: US specialist, MRI with O-RADS MRI score, or per gyn-oncologist Clinical Follow-up Gynecologist with gyn-oncologist consultation IMPRESSION Multilocular smooth cyst with CS 4 (O-RADS 4): Options: US specialist, MRI with O-RADS MRI score, or per gyn-oncologist
Path 5.4.4: Multilocular, Irregular Clicks: 4
Result: O-RADS 4 Field Value Score 4 Category Intermediate Risk - Irregular Multilocular Risk 10–<50% Description Multilocular cyst with irregular inner wall/septations Management US specialist, MRI, or per gyn-oncologist protocol Imaging Follow-up Options: US specialist, MRI with O-RADS MRI score, or per gyn-oncologist Clinical Follow-up Gynecologist with gyn-oncologist consultation IMPRESSION Multilocular cyst with irregular inner wall/septations (O-RADS 4): Options: US specialist, MRI with O-RADS MRI score, or per gyn-oncologist
Path 6: Solid Mass (Branch D) Path 6.1: Irregular Contour Clicks: 2
Result: O-RADS 5 Field Value Score 5 Category High Risk - Irregular Solid Risk ≥50% Description Solid lesion with irregular contour Management Refer to gynecologic oncologist Imaging Follow-up Per gyn-oncologist protocol Clinical Follow-up Gyn-oncologist IMPRESSION Solid lesion with irregular contour (O-RADS 5): Per gyn-oncologist protocol
Path 6.2: Smooth Contour with Shadowing Path 6.2.1: Smooth, Shadowing, CS 1 Clicks: 4
Result: O-RADS 3 Field Value Score 3 Category Low Risk - Avascular Solid Risk 1–<10% Description Solid smooth lesion with CS 1 (no flow), ± shadowing Management Consider US specialist or MRI; Gynecologist consultation Imaging Follow-up Consider follow-up US within 6 months if not excised; may consider US specialist or MRI Clinical Follow-up Gynecologist IMPRESSION Solid smooth lesion with CS 1 (no flow), ± shadowing (O-RADS 3): Consider follow-up US within 6 months if not excised; may consider US specialist or MRI
Path 6.2.2: Smooth, Shadowing, CS 2-3 Clicks: 4
Result: O-RADS 3 Field Value Score 3 Category Low Risk - Shadowing Solid Risk 1–<10% Description Solid smooth lesion with shadowing and CS 2 Management Consider US specialist or MRI; Gynecologist consultation Imaging Follow-up Consider follow-up US within 6 months if not excised Clinical Follow-up Gynecologist IMPRESSION Solid smooth lesion with shadowing and CS 2 (O-RADS 3): Consider follow-up US within 6 months if not excised
Path 6.2.3: Smooth, Shadowing, CS 4 Clicks: 4
Result: O-RADS 5 Field Value Score 5 Category High Risk - Highly Vascular Solid Risk ≥50% Description Solid smooth lesion with CS 4 (very strong flow) Management Refer to gynecologic oncologist Imaging Follow-up Per gyn-oncologist protocol Clinical Follow-up Gyn-oncologist IMPRESSION Solid smooth lesion with CS 4 (very strong flow) (O-RADS 5): Per gyn-oncologist protocol
Path 6.3: Smooth Contour without Shadowing Path 6.3.1: Smooth, No Shadowing, CS 1 Clicks: 4
Result: O-RADS 3 Field Value Score 3 Category Low Risk - Avascular Solid Risk 1–<10% Description Solid smooth lesion with CS 1 (no flow), ± shadowing Management Consider US specialist or MRI; Gynecologist consultation Imaging Follow-up Consider follow-up US within 6 months if not excised; may consider US specialist or MRI Clinical Follow-up Gynecologist IMPRESSION Solid smooth lesion with CS 1 (no flow), ± shadowing (O-RADS 3): Consider follow-up US within 6 months if not excised; may consider US specialist or MRI
Path 6.3.2: Smooth, No Shadowing, CS 2-3 Clicks: 4
Result: O-RADS 4 Field Value Score 4 Category Intermediate Risk - Vascular Solid Risk 10–<50% Description Solid smooth lesion, non-shadowing, CS 2 Management US specialist, MRI, or per gyn-oncologist protocol Imaging Follow-up Options: US specialist, MRI with O-RADS MRI score, or per gyn-oncologist Clinical Follow-up Gynecologist with gyn-oncologist consultation IMPRESSION Solid smooth lesion, non-shadowing, CS 2 (O-RADS 4): Options: US specialist, MRI with O-RADS MRI score, or per gyn-oncologist
Path 6.3.3: Smooth, No Shadowing, CS 4 Clicks: 4
Result: O-RADS 5 Field Value Score 5 Category High Risk - Highly Vascular Solid Risk ≥50% Description Solid smooth lesion with CS 4 (very strong flow) Management Refer to gynecologic oncologist Imaging Follow-up Per gyn-oncologist protocol Clinical Follow-up Gyn-oncologist IMPRESSION Solid smooth lesion with CS 4 (very strong flow) (O-RADS 5): Per gyn-oncologist protocol
Path 7: Ascites / Peritoneal Nodules Clicks: 1
Result: O-RADS 5 Field Value Score 5 Category High Risk - Ascites/Peritoneal Nodules Risk ≥50% Description Ascites and/or peritoneal nodules (not due to other etiologies) Management Refer to gynecologic oncologist Imaging Follow-up Per gyn-oncologist protocol Clinical Follow-up Gyn-oncologist IMPRESSION Ascites and/or peritoneal nodules (not due to other etiologies) (O-RADS 5): Per gyn-oncologist protocol
Summary Statistics Total Unique Paths: 41 Branch Number of Paths Normal/Incomplete/Ascites 3 Simple Cyst 6 Classic Benign 14 Cystic Non-Classic 12 Solid Mass 7
Results by O-RADS Score Score Count Percentage O-RADS 0 1 2.4% O-RADS 1 2 4.9% O-RADS 2 16 39.0% O-RADS 3 12 29.3% O-RADS 4 6 14.6% O-RADS 5 4 9.8%
Click Depth Distribution Glossary Term Definition CS Color Score - degree of intralesional vascularity (1=none, 2=minimal, 3=moderate, 4=very strong) Solid component Protrudes ≥3mm into cyst lumen from wall/septation Papillary projection Solid component surrounded by fluid on 3 sides Unilocular Single locule (no complete septa) Bilocular 2 locules (1 complete septation) Multilocular ≥3 locules (≥2 complete septations) Smooth Uniform/even inner margin Irregular Non-uniform inner margin; focal wall thickening <3mm Shadowing Broad or diffuse hypoechogenicity posterior to lesion Postmenopausal ≥1 year amenorrhea (or age >50 if uncertain) Early postmenopausal <5 years postmenopausal (or age 50-55) Late postmenopausal ≥5 years postmenopausal (or age ≥55)
Generated from O-RADS US v2022 (ACR, November 2022)