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Abstract
Objective
This study is to investigate and compare the pregnancy outcomes and prognostic factors of congenital cystic adenomatoid malformation (CCAM) and bronchopulmonary sequestration (BPS).
Methods
From May 2005 to September 2010, fifty-five medical records of fetuses with prenatally diagnosed CCAM (42 cases) and BPS (13 cases) were reviewed retrospectively in Samsung Medical Center (SMC). We compared the demographic characteristics, sonographic findings, postnatal diagnoses and pregnancy outcomes between CCAM and BPS. The sonographic findings included the locations of lesion, changes of size, existences of mediastinal shift, associated anomalies and existences of hydrops. Postnatal diagnoses were confirmed by pathologic findings and image examinations.
Results
A total of fifty-five cases were prenatally diagnosed as CCAM (42 cases) and BPS (13 cases). Thirty cases were followed up in SMC. Three of the thirty cases underwent termination and one case was intrauterine fetal death. Twenty-six cases were delivered alive in SMC. The masses were found out to be disappeared by prenatal sonography in four cases (15.4%) who were antenatally diagnosed as CCAM. The sizes of the mass were decreased more than 50% in CCAM seven cases and BPS three cases. The absence of mediastinal shift (P=0.019) was significantly correlated with the decrease of mass size.
Conclusion
The concordance rate between antenatal and postnatal diagnosis was 63.0%. There was a tendency of decreasing in lesion with most of the cases. Without mediastinal shift, the mass size decreased significantly. So, existence of mediastinal shift is the most important prognostic factor of CCAM and BPS.
Figures and Tables
Fig. 1
Transverse sonogram of the fetal chest shows a multicystic lung mass of congenital cystic adenomatoid malformation (white arrow). H, heart.
Fig. 2
Transverse sonogram of the fetal chest shows an echogenic lung mass of bronchopulmonary sequestration (white dotted line).
Fig. 3
Overall of pregnancy outcome of 55 cases prenatally diagnosed congenital cystic adenomatoid malformation and bronchopulmonary sequestration. F/U, follow-up; TOP, termination of pregnancy; FDIU, fetal death in uterus.
Table 2
Diagnostic sensitivity and specificity and predictive value of CCAM and BPS
Sensitivity value: CCAM 0.7 (70.0%); BPS 0.42 (42.9%).
Speciticity value: CCAM 0.42 (42.9%); BPS 0.7 (70.0%).
Positive predictive value: CCAM 0.78 (77.8%); BPS 0.67 (66.7%).
Pegative predictive value: CCAM 0.33 (33.3%); BPS 0.78 (77.8%).
CCAM, congenital cystic adenomatoid malformation; BPS, bronchopulmonary sequestration.
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