BAPS Papers
Prenatal diagnosis and outcome of fetal lung masses

https://doi.org/10.1016/j.jpedsurg.2010.11.004Get rights and content

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.

Section snippets

Patient population

After approval from the institutional review board of the Baylor College of Medicine (protocol no. H-20983), the case records and diagnostic imaging studies of all fetuses referred to the Texas Children's Fetal Center between July 1, 2001 and May 30, 2010 with a diagnosis of fetal lung mass were reviewed retrospectively. Fetuses found to have diaphragm hernia (with or without an associated bronchopulmonary sequestration) were excluded. All patients referred to our center underwent comprehensive

Results

During the study period, 82 fetuses (41 male) were evaluated for a confirmed fetal lung mass in the absence of diaphragmatic hernia. Fifty-three fetuses (65%) had left-sided lesions, 28 (34%) had right-sided lesions, and 1 fetus had bilateral lesions identified. The mean age at diagnosis, known for 77 fetuses, was 21.7 ± 4.5 weeks, and the mean age at consultation in our center was 27.1 ± 5.1 weeks of gestation. Seventy-three fetuses had at least 1 fetal MRI performed at 26.1 ± 3.1 weeks of

Discussion

It seems intuitive that the size of the fetal lung mass correlates with outcome. Larger rapidly growing masses may compress the mediastinum and esophagus, leading to impaired fetal swallowing and polyhydramnios and, ultimately, fetal death. This process was elucidated by Rice et al [8] in a sheep model in which balloon tissue expanders were gradually inflated in the thorax of 120-day-old fetal lambs. As the balloon was expanded, these fetal lambs developed signs of hydrops with ascites and

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