Design: Retrospective cohort study of patients with ORADS scores who underwent surgical intervention. Primary outcomes were referral rates, oophorectomy vs ovarian-sparing procedure in pre-menopausal patients, and surgical route. Secondary outcome was the proportion of malignancy by ORADS score.

Setting: Single tertiary academic center. Surgeries performed by benign GYN providers, MIGS specialists, or GYN Oncologists

Patients or Participants: 284 female patients (age 8-82) who underwent surgery following ORADS scoring

Interventions: N/A

Measurements and Main Results: The proportion of surgeries performed by GYN Oncology were ORADS 2 (<1% risk of malignancy): 40% [95% CI 26.41%-54.82%], ORADS 3 (1-5% risk): 55.88% [43.32%-67.92%], ORADS 4: 87.27% [79.57%-92.86%], and ORADS 5: 100% [*97.5% CI 91.96%-100%]. There were no malignancies for ORADS 1 (n=7) or ORADS 2 (n=50) masses. The observed rates of malignancy were ORADS 3: 5.88% [1.63%-14.38%], ORADS 4: 7.27% [3.19%-13.83%], and ORADS 5 43.18% [28.35%-58.97%]. In pre-menopausal patients, the odds of oophorectomy vs ovarian-sparing treatment adjusted for age and ORADS score was 6.82 [2.25-20.66] for surgeries performed by GYN Oncology vs benign providers. The adjusted odds of open vs minimally invasive surgery performed by GYN Oncology was 2.18 [0.857-5.56].

Conclusion: Patients with ORADS 2 and 3 masses are often treated by GYN Oncology despite being low risk. While these patients are offered minimally invasive surgery at similar rates to patients of benign GYN providers, they are more likely to receive oophorectomy than ovarian-sparing treatment. Our observed rates of malignancy also approximate previously published validation data of ORADS scoring.