Background: The findings of this study suggest that the Ovarian-Adnexal 
Reporting and Data System (O-RADS) ultrasound risk stratification system are 
scoring algorithm that can be applied to a non-selected population of women 
undergoing ultrasonography examinations in radiology departments with similar 
diagnostic performance compared with previously studied populations. 
Aim of study: The study aimed to evaluate the ovarian lesions as regarding 
malignancy rate, the validity and reliability through different pathological 
results and other imaging modalities mainly the MRI.
Patients and Methods: This study is a prospective study included seventy 
seven patients (fifty pre and twenty seven postmenopausal) referred from out-
patient oncology clinics or in-patients at departments of South Egypt Cancer 
Institute (SECI) for assessing a suspicious adnexal mass lesion. Their ages 
ranged from 16- 75 years. 
Results: The studied lesions were as following as regard (the ORADS) 15 
(16.7%), 38 (42.2%), 5 (5.6%), 4 (4.4%) and 28 (31.1%) lesions were classified 
as ORADS caterory-1, 2, 3, 4 and 5, respectively. The main findings in the 
current study were that O-RADS at cutoff point> 4; it has 96.6% overall 
accuracy in diagnosis of nature of ovarian lesions with area under curve (AUC) 
was 0.986. 
Conclusion: the ultrasound O-RADS classification system provide a crucial 
non-invasive diagnostic tool for suspected ovarian tumors to distinguish 
between benign and malignant neoplastic lesions,