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.

Approach:

• Study Design: Retrospective study including 501 pediatric patients with adnexal masses classified according to the O-RADS ultrasound lexicon.
• Age Groups: Patients were divided into three age groups: school-age children, early adolescents, and middle adolescents.
• Diagnostic Performance Assessment: Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and area under the curve (AUC) were calculated for each age group.

Key Findings:

• In school-age children, sensitivity and NPV were both 100.0%, specificity 93.6%, and AUC 0.968.
• In early adolescents, sensitivity was 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.
• 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).

Interpretation:

Limitations:

• The study is retrospective and may be subject to selection bias.
• The sample size for school-age children was relatively small compared to other age groups.

Conclusion: