Endometriosis: assessment on O-RADS and risk of malignant transformation

Krista Elise Suarez-Weiss; Krupa Patel-Lippmann; Catherine Phillips; Kristine Burk; Angela Tong; Hina Arif; Refky Nicola; Priyanka Jha

doi:10.1007/s00261-025-04885-0

Endometriosis: assessment on O-RADS and risk of malignant transformation

Abdom Radiol (NY). 2025 Mar 26. doi: 10.1007/s00261-025-04885-0. Online ahead of print.

Authors

Krista Elise Suarez-Weiss¹, Krupa Patel-Lippmann², Catherine Phillips², Kristine Burk³, Angela Tong⁴, Hina Arif⁵, Refky Nicola⁶, Priyanka Jha⁷

Affiliations

¹ Brown University Health, Providence, RI, USA. ksuarezweiss@brownhealth.org.
² Vanderbilt University Medical Center, Nashville, USA.
³ Brigham and Women's Hospital, Boston, USA.
⁴ New York University Langone Medical Center, New York, USA.
⁵ University of Arizona, Tucson, USA.
⁶ SUNY Upstate Medical University, Syracuse, USA.
⁷ Stanford Medicine, Stanford, USA. jhap@stanford.edu.

PMID: 40137947
DOI: 10.1007/s00261-025-04885-0

Abstract

Endometriosis is a common disease, affecting approximately 10% of women of reproductive age. Several intersecting guidelines and consensus statements provide information on imaging diagnosis and surveillance strategies for endometriomas. SRU consensus panel recommendations provide information on initial detection of endometriosis on routine pelvic imaging. Revised American Society of Reproductive Medicine (rASRM) classification, the #ENZIAN classification, and the deep pelvic endometriosis index (dPEI) aim to assess the overall extent of disease and assist in presurgical planning. The Ovarian-Adnexal Reporting and Data System (O-RADS) aims to risk stratify lesions evaluated with US or MR based on their imaging morphology, from typical benign lesions to atypical presentations and malignant transformation. Emerging data shows increased risk of ovarian cancer in patients with endometriosis, especially following menopause and in those patients with long standing endometriosis. (Chen et al. in Front Oncol. 14:1329133, 2024;Streuli et al. in Climacteric. 20:138-143, 2017;Secosan et al. in Diagnostics (Basel). 10:134, 2020;Inceboz in Womens Health (Lond Engl). 11:711-715, 2015;Cassani et al. in Maturitas. 190, 2024;Gemmell et al. in Hum Reprod Update. 23:481-500, 2017;Giannella et al. in Cancers (Basel). 13:4026, 2021;) Current O-RADS guidelines mandate follow-up of endometriomas up to 2 years with further follow-up based on clinical factors. No consensus guidelines exist for imaging surveillance of patients with deep endometriosis from a malignancy standpoint. This review explores the imaging appearance of endometriomas, imaging features of malignant transformation, surveillance strategies and gaps in current literature, and attempts to better understand the risk of malignancy and to encourage further research for long-term imaging surveillance of endometriosis patients.

Keywords: Endometrioisis; MRI; Malignancy; O-RADS; Surveillance; Ultrasound.

Publication types

Review