Institute of Obstetrical and Gynecological Imaging, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (f)Department of Pathology, Meir Medical Center, Kfar Saba, Israel.
Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (f)Department of Pathology, Meir Medical Center, Kfar Saba, Israel.
Am J Obstet Gynecol. 2022 Dec;227(6):897.e1-897.e9. doi: 10.1016/j.ajog.2022.06.065. Epub 2022 Aug 5.
Esophageal atresia is a major anomaly of varying severity. The complexity of surgical correction depends on the presence of a distal fistula.
This study aimed to determine the feasibility and accuracy of prenatal ultrasound detection of the distal fistula in fetuses diagnosed with esophageal atresia.
This was an observational study conducted at a single tertiary care center between 2019 and 2021. Included were pregnant patients carrying a fetus prenatally diagnosed with esophageal atresia that was confirmed postnatally during corrective surgery or at postmortem autopsy. During the scan, the performing investigator determined the presence or absence of a distal fistula by scanning the location of the lower esophagus during fetal breathing. Cases in which the lower esophagus was observed distending with amniotic fluid during breathing were deemed "fistula present," and the remaining cases "fistula absent." Test feasibility and performance indices, including sensitivity, specificity, and positive and negative predictive value were calculated. The offline clips and images were reviewed by 2 investigators for the assessment of interoperator agreement using Cohen's Kappa formula.
Included were 16 fetuses with esophageal atresia scanned between 2019 and 2021. All fetuses were successfully scanned with sufficient resolution of the area of interest during at least 3 cycles of breathing. It took a median of 8.5 minutes to determine the presence or absence of a distal fistula. The feasibility of the test was 100% (16/16). The test's sensitivity, specificity, and positive and negative predictive values were 80% (95% confidence interval, 55-100), 100% (95% confidence interval, 60-100), 100% (95% confidence interval, 65-100), and 75% (95% confidence interval, 45-100), respectively. The Cohen's Kappa for interoperator agreement was calculated to be 1, P<.001, corresponding to a "perfect" level of agreement.
Distal fistulas in esophageal atresia can be demonstrated prenatally by targeted scanning using appropriate technique. The method provided is feasible, reproducible, and has excellent performance indices. This novel technique and observations may improve the prenatal diagnosis and counseling of esophageal atresia.
食管闭锁是一种严重程度不同的主要畸形。手术矫正的复杂性取决于是否存在远端瘘管。
本研究旨在确定产前超声检测在诊断为食管闭锁胎儿中远端瘘管的可行性和准确性。
这是一项单中心回顾性研究，于 2019 年至 2021 年在一家三级保健中心进行。研究对象为产前诊断为食管闭锁的孕妇，这些孕妇在矫正手术或死后尸检时被证实存在食管闭锁。在扫描过程中，执行研究者通过扫描胎儿呼吸时下食管的位置来确定是否存在远端瘘管。如果在下食管观察到羊水扩张，则认为存在瘘管，其余则认为不存在瘘管。计算检测的可行性和性能指标，包括灵敏度、特异性、阳性和阴性预测值。通过 Cohen Kappa 公式对 2 名研究者离线剪辑和图像进行评估，以评估操作者间的一致性。
纳入了 16 例 2019 年至 2021 年扫描的食管闭锁胎儿。所有胎儿均成功扫描，在至少 3 个呼吸周期中均能充分分辨感兴趣区域。确定是否存在远端瘘管的中位数时间为 8.5 分钟。该检测的可行性为 100%（16/16）。该检测的灵敏度、特异性、阳性和阴性预测值分别为 80%（95%置信区间，55-100）、100%（95%置信区间，60-100）、100%（95%置信区间，65-100）和 75%（95%置信区间，45-100）。两名操作者之间的 Cohen Kappa 计算为 1，P<.001，对应于“完美”的一致性水平。
通过使用适当的技术对食管闭锁进行靶向扫描，可以在产前显示远端瘘管。该方法具有可行性、可重复性和良好的性能指标。这种新技术和观察结果可能会提高食管闭锁的产前诊断和咨询。
