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Prenatal diagnosis and outcome of fetal lung masses
Authors:Cass Darrell L  Olutoye Oluyinka O  Cassady Christopher I  Moise Kenneth J  Johnson Anthony  Papanna Ramesha  Lazar David A  Ayres Nancy A  Belleza-Bascon Bella
Institution:
  • Texas Children's Fetal Center and the Michael E. DeBakey Department of Surgery, and Departments of Obstetrics and Gynecology and Radiology, Baylor College of Medicine, Houston, TX 77030, USA
  • Abstract:

    Aim

    The purpose of this study is to evaluate the accuracy of prenatal diagnostic features, particularly congenital cystic adenomatoid malformation volume ratio (CVR), in predicting outcomes for fetuses with lung masses.

    Methods

    The records and imaging features of all fetuses referred to the Texas Children's Fetal Center with a fetal lung mass between July 2001 and May 2010 were reviewed retrospectively. Data collected included gestational age (GA) at diagnosis, fetal magnetic resonance imaging findings, CVR, mass size, nature of fetal treatment, surgical findings, pathology, and outcome. Data were analyzed for predicting development of hydrops or the need for fetal therapy using receiver operating characteristic curves.

    Results

    Of 82 fetuses (41 male) evaluated for a lung mass, 53 (65%) were left-sided (1 bilateral), and the mean (SD) GA at diagnosis was 21.5 (4.3) weeks. Seventy-three fetuses underwent fetal magnetic resonance imaging at a mean (SD) GA of 26.1 (4.6) weeks. Thirteen fetuses (16%) had fetal treatment. Four fetuses with hydrops underwent open fetal surgical resection, and 3 survived. Six fetuses with large lung masses and persistent mediastinal compression near term underwent ex-utero intrapartum therapy-to-resection procedures, and 3 fetuses with hydrops underwent serial thoracentesis. Congenital cystic adenomatoid malformation volume ratio correlated strongly with the development of hydrops and the need for fetal therapy with an area under the receiver operating characteristic curve of 0.96 (P < .0001) and 0.88 (P < .0001), respectively. Of 18 fetuses with a CVR greater than 2.0 compared with 2 (3%) of 60 with a CVR of 2.0 or less, 10 (56%) required fetal intervention (P < .0001).

    Conclusion

    Congenital cystic adenomatoid malformation volume ratio correlates strongly with the development of fetal hydrops and the need for fetal intervention. A threshold value of 2.0 yields the most powerful statistical results.
    Keywords:Congenital cystic adenomatoid malformation  Congenital lung malformation  Fetal surgery  Fetal thoracentesis  CCAM volume ratio  CVR  Fetal hydrops  Fetal surgery  Prenatal steroids  Pulmonary mesenchymal neoplasm
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