This retrospective study, conducted at the Ultrasound Department of Al-Auda Medical Center in Hafr Al-Batin, KSA, evaluated the diagnostic performance and clinical utility of the Gynecologic Imaging-Reporting and Data System (GI-RADS) for the risk stratification of adnexal masses. Over a three-year period (December 2022 to December 2025), 300 patients presenting with suspected adnexal masses underwent standardized transabdominal and transvaginal sonography using high-resolution systems. The results indicate that the majority of adnexal masses were low-risk, with 51.7% categorized as GI-RADS 3 (Probably Benign) and 36.3% as GI-RADS 2 (Benign). Findings suspicious for malignancy were rare, with 8.0% classified as GI-RADS 4 and 2.0% as GI-RADS 5. Statistical analysis revealed highly significant associations ($p=0.000$) between GI-RADS stratification and parameters such as cystic content, internal vascularity, and the presence of ascites, with vascularity demonstrating the strongest correlation (Cramer’s V=0.458). Conversely, septal and wall thickness were not statistically significant discriminators in this cohort (p=0.088). In conclusion, the GI-RADS framework proved to be a reliable, standardized tool for characterizing adnexal lesions at our institution. The system effectively reduced diagnostic ambiguity, facilitating consistent clinical triage and communication between sonographers and clinicians. These findings support the widespread adoption of GI-RADS as a mandatory reporting standard to improve diagnostic accuracy, reduce unnecessary interventions for benign lesions, and prioritize urgent management for high-risk patients. This audit provides essential evidence-based justification for maintaining GI-RADS as the primary reporting protocol at Al-Auda Medical Center.