Objective To evaluate the diagnostic capability of the Ovarian Adnexal Reporting Data System , which is used to classify the adnexal masses with transvagina?ultrasound. Methods? A computer search was conducted on PubMed, EMbase , Cochrane Library and Web of Science to collect diagnostic accuracy studies related to the purpose of the study. From the inception of the database until September 19, 2023, a comprehensive search was conducted. Results ?In total, 23 studies involving 13,031 women with 13,372 lumps were included. The results of the meta-analysis indicated a sensitivity (SEN) of 0.95 [95%CI (0.92, 0.97)], specificity (SPE) of 0.81[95%CI (0.76, 0.85), positive likelihood ratio (PLR) of 5.0[95%CI (4.0,6.1)], negative likelihood ratio (NLR) of 0.06[95%CI (0.04,0.09)], and diagnostic odds ratio (DOR) of 85[95%CI (50,145)]. The lower area of the integrated receiver operating characteristics (SROC) curve reached 0.94[95% CI(0.91,0.96)].? Conclusion?The O-RADS risk stratification system demonstrates excellent accuracy, with high sensitivity, and moderate specificity in distinguishing between benign and malignant ovarian tumors. The inter-rater agreement is commendable, highlighting its significant clinical utility.