Departments of Obstetrics and Gynecology, University of Schleswig-Holstein, Campus Lübeck, Germany.
Eur J Obstet Gynecol Reprod Biol. 2013 Apr;167(2):160-6. doi: 10.1016/j.ejogrb.2012.11.023. Epub 2013 Jan 5.
To describe the varieties and ultrasound characteristics of prenatally diagnosed fetal abdominal tumors and to scrutinize the accuracy of prenatal diagnosis as well as the postnatal outcome and therapy of affected pregnancies.
Retrospective study of 354 fetuses found to have abdominal tumors on prenatal sonogram, identified from 1993 to 2009 at a tertiary referral center for prenatal medicine. The cohort was classified into subgroups according to the sonographic appearance of the fetal tumor and the affected anatomic structure (urinary, gastrointestinal and genital tracts and other locations). Sensitivity, specificity, positive predictive value and false-positive rate of ultrasonography in identifying the system of origin were calculated. Relationships between relevant outcome domains and the different subgroups were assessed using the chi-square test and Fisher's exact test.
Our cohort comprised 222 urinary tract lesions, 37 genital tract lesions, 80 gastrointestinal lesions and 15 tumors of other origins. The mean gestational age at diagnosis was 26+0 wks. The prenatally established diagnosis was exactly concordant with postnatal findings in 88.9%. Sensitivity, specificity, positive predictive value and false-positive rate of ultrasonography in identifying the system of origin (urinary, gastrointestinal, genital tracts and other locations) were 98.3%, 97.6%, 92.6% and 2.4%, respectively. The favorable postnatal outcome rate was highest among fetuses with genital tract lesions (95%) and lowest among those with tumors of the urinary tract (62%, p=<0.001). Twenty per cent of tumors regressed spontaneously, mostly gastrointestinal tumors (36%, p=<0.001). In 75/354 cases (21%) the parents opted to terminate the pregnancy: intra-uterine fetal demise and neonatal death were each noted in 4%. Prenatal therapy was performed in 24 of 354 cases (7%) and postnatal surgery in 64 cases (18%).
The majority of fetal abdominal anomalies were accurately diagnosed and the vast majority of affected fetuses had a favorable outcome, some tumors even resolved with advancing pregnancy. Pre- and post-natal invasive surgical interventions were mandatory in only a small number of cases.
描述产前诊断出的胎儿腹部肿瘤的种类和超声特征，并探讨产前诊断的准确性以及受影响妊娠的产后结局和治疗方法。
对 1993 年至 2009 年在产前医学三级转诊中心进行产前超声检查时发现的 354 例胎儿腹部肿瘤进行回顾性研究。该队列根据胎儿肿瘤的超声表现和受影响的解剖结构（泌尿系统、胃肠道和生殖器官以及其他部位）分为亚组。计算超声识别起源系统的敏感性、特异性、阳性预测值和假阳性率。使用卡方检验和 Fisher 确切检验评估相关结局领域与不同亚组之间的关系。
我们的队列包括 222 例泌尿系统病变、37 例生殖系统病变、80 例胃肠道病变和 15 例其他起源的肿瘤。诊断时的平均孕周为 26+0 周。产前诊断与产后发现完全一致的比例为 88.9%。超声识别起源系统（泌尿系统、胃肠道、生殖器官和其他部位）的敏感性、特异性、阳性预测值和假阳性率分别为 98.3%、97.6%、92.6%和 2.4%。生殖系统病变胎儿的产后结局最好（95%），泌尿系统病变胎儿的结局最差（62%，p<0.001）。20%的肿瘤自发消退，主要是胃肠道肿瘤（36%，p<0.001）。在 354 例病例中，有 75 例（21%）父母选择终止妊娠：宫内胎儿死亡和新生儿死亡各占 4%。在 354 例病例中，有 24 例（7%）进行了产前治疗，64 例（18%）进行了产后手术。
大多数胎儿腹部异常得到了准确诊断，绝大多数受影响的胎儿结局良好，一些肿瘤甚至随着妊娠的进展而消退。只有少数病例需要进行产前和产后的有创性手术干预。
