Ultrasound grading standard for benign versus malignant adnexal masses

Benign

Clear, smooth

Absent

Absent

Absent

Benign

Clear, smooth

Homogeneous, regular

Thin, uniform

Absent

Borderline or suspicious for malignancy

Clear, irregular

Slightly heterogeneous, partially irregular

Relatively thick, partially uneven

Absent

Malignant

Unclear, poorly defined

Completely irregular

Thick, uneven

Present

Takeuchi grading evaluates tumors based on the outer wall, septa, internal structure, and other sonographic features, classifying them into three grades: Grade 0 indicates benign lesions, Grade I indicates suspicious malignancy, and Grade II indicates malignant lesions.
In China, Xu Ling et al. adapted the above criteria and established a simplified and practical grading system mainly based on ultrasound imaging characteristics. The grading criteria are shown in the table above. The system consists of four grades: Grades 0 and 1 are considered benign, Grade 2 is considered borderline or suspicious for malignancy, and Grade 3 is considered malignant. This system is used to differentiate benign from malignant lesions.