Diagnostic accuracy of imaging studies in congenital lung malformations.
fetal medicine
lung
paediatric surgery
Journal
Archives of disease in childhood. Fetal and neonatal edition
ISSN: 1468-2052
Titre abrégé: Arch Dis Child Fetal Neonatal Ed
Pays: England
ID NLM: 9501297
Informations de publication
Date de publication:
Jul 2019
Jul 2019
Historique:
received:
14
02
2018
revised:
22
06
2018
accepted:
04
07
2018
pubmed:
28
7
2018
medline:
27
6
2019
entrez:
28
7
2018
Statut:
ppublish
Résumé
Although fetal ultrasound, fetal MRI and postnatal CT are now widely used in the evaluation of congenital lung malformations (CLM), their diagnostic accuracy remains undefined. To correlate prenatal and postnatal imaging studies with pathological data after CLM resection. Retrospective, descriptive case series study. A North American tertiary care centre. One hundred and three consecutive lung resections for a suspected CLM between 1 January 2005 and 31 December 2015. Diagnostic accuracy of imaging diagnosis compared with pathological evaluation. Pathological diagnoses included congenital pulmonary airway malformation ((CPAM) n=45, 44%), bronchopulmonary sequestration (BPS; n=25, 24%), CPAM/BPS hybrid lesions (n=22, 21%) and pleuropulmonary blastoma (n=2, 2%). Fetal ultrasound detected 85 (82.5%) lesions and correctly diagnosed whether or not a lesion was a CPAM in 75% of cases (sensitivity 93%, specificity 32%). Fetal MRI had a similar concordance rate (73%) but was superior in correctly determining whether a systemic feeding vessel was present in 80% of cases (sensitivity 71%, specificity 88%) compared with an ultrasound accuracy rate of 72% (sensitivity 49%, specificity 93%). By comparison, postnatal CT correctly diagnosed whether a CPAM was present in 84% of cases (sensitivity 86%, specificity 77%) and whether a systemic feeding vessel was present in 90% of cases (sensitivity 92%, specificity 88%). Fetal ultrasound remains an important tool in the detection and evaluation of congenital lung malformations. However, it does not correctly predict histology in approximately 25% of prenatally detected CLMs and remains limited by relatively poor sensitivity for systemic feeding vessels pathognomic for a bronchopulmonary sequestration. These data suggest the importance of obtaining additional cross-sectional imaging, preferably a postnatal CT scan, in all patients to help counsel families and to guide in the optimal management of these lesions.
Sections du résumé
BACKGROUND
BACKGROUND
Although fetal ultrasound, fetal MRI and postnatal CT are now widely used in the evaluation of congenital lung malformations (CLM), their diagnostic accuracy remains undefined.
OBJECTIVE
OBJECTIVE
To correlate prenatal and postnatal imaging studies with pathological data after CLM resection.
DESIGN
METHODS
Retrospective, descriptive case series study.
SETTING
METHODS
A North American tertiary care centre.
PATIENTS
METHODS
One hundred and three consecutive lung resections for a suspected CLM between 1 January 2005 and 31 December 2015.
MAIN OUTCOME MEASURES
METHODS
Diagnostic accuracy of imaging diagnosis compared with pathological evaluation.
RESULTS
RESULTS
Pathological diagnoses included congenital pulmonary airway malformation ((CPAM) n=45, 44%), bronchopulmonary sequestration (BPS; n=25, 24%), CPAM/BPS hybrid lesions (n=22, 21%) and pleuropulmonary blastoma (n=2, 2%). Fetal ultrasound detected 85 (82.5%) lesions and correctly diagnosed whether or not a lesion was a CPAM in 75% of cases (sensitivity 93%, specificity 32%). Fetal MRI had a similar concordance rate (73%) but was superior in correctly determining whether a systemic feeding vessel was present in 80% of cases (sensitivity 71%, specificity 88%) compared with an ultrasound accuracy rate of 72% (sensitivity 49%, specificity 93%). By comparison, postnatal CT correctly diagnosed whether a CPAM was present in 84% of cases (sensitivity 86%, specificity 77%) and whether a systemic feeding vessel was present in 90% of cases (sensitivity 92%, specificity 88%).
CONCLUSIONS
CONCLUSIONS
Fetal ultrasound remains an important tool in the detection and evaluation of congenital lung malformations. However, it does not correctly predict histology in approximately 25% of prenatally detected CLMs and remains limited by relatively poor sensitivity for systemic feeding vessels pathognomic for a bronchopulmonary sequestration. These data suggest the importance of obtaining additional cross-sectional imaging, preferably a postnatal CT scan, in all patients to help counsel families and to guide in the optimal management of these lesions.
Identifiants
pubmed: 30049725
pii: archdischild-2018-314979
doi: 10.1136/archdischild-2018-314979
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
F372-F377Informations de copyright
© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.