Evaluation Of The Prognosis Of Congenital Cystic Adenomatoid Malformation Using The Ratio Of Tumor Volume To Fetal Femur Length

Objective: The prenatal diagnosis of congenital cystic adenomatoid malformation(CCAM)was performed by ultrasound and sub-typed.The ratio of tumor volume to fetal femur length and the ratio of tumor volume to fetal head circumference were calculated.To evaluate the relationship between CCAM classification and the above ratio and the prognosis of the disease,provide the basis for clinical consultation and treatment.Methods: Retrospective analysis from January 2015 to June 2016 in our hospital ultrasound diagnosis of CCAM in 41 cases,the application of GE Voluson E8 and E10 ultrasound system,two-dimensional probe frequency of 1.6-4.5MHz,Three-dimensional volume probe frequency is 4-8MHz,set to obstetric ultrasound program,carefully observe the fetal development of each system and appendages.When abnormal pulmonary masses were found,the size and location of the abnormal lung masses were observed.Other abnormalities such as mediastinal displacement,fetal edema and polyhydramnios were observed.The high definition flow(HD flow)was used to search for the blood vessels of the tumor.According to the size of the vesicle,the ratio of tumor volume to fetal femur length was calculated,calculate the ratio of tumor volume to fetal head circumference(volume to head circumference ratio,CVR).Pregnant women in the prenatal examination once every three weeks to observe changes in fetal lung mass,the birth of children follow-up after birth,CT examination results.Prenatal was divided into two groups: 1.The better prognosis group;2.The poor prognosis group.The ratio of tumor volume to fetal femur length and the CVR were recorded in each group.The receiver operating characteristic curve(ROC curve)was used to find the cut-off value of each group,and it was better to compare which ratio to evaluate the prognosis of CCAM.The different types of CCAM outcomes observed by prenatal ultrasound were compared with postnatal CT results to evaluate the accuracy of ultrasound in predicting the disappearance of CCAM in the third trimester of pregnancy and the prognosis of different types of CCAM.Result: 1.Prenatal ultrasound diagnosis of 41 cases of CCAM,9 cases(22.0%)prenatal tumor enlargement or even serious complications such as edema and complications,of which 7 cases of induced labor,and the remaining 32 cases(78.0%)prenatal and postpartum in good condition.2.The critical value of prenatal two groups of ratio of tumor volume to fetal femur length was 8.73,area under curve(Area Under Curve,AUC)AUC of 0.840,P <0.05 was statistically significant.3.The prenatal two groups of fetus CVR of the critical value of 1.77,area under the curve AUC of 0.840,P <0.05 was statistically significant.4.Prenatal ultrasound predict the final disappearance of CCAM tumor sensitivity was 78.26%,specificity was 75%,the positive predictive value was 94.73%,the negative predictive value was 37.5%,the diagnostic accuracy was 77.78%.Successful follow-up of 27 cases of CCAM in postpartum children,CT examination only 4 cases no lung tumor,including CCAM II type 1,CCAM III type 3 cases.Conclusion: 1.Prenatal CCAM has a trend of regression,ratio of tumor volume to fetal femur length<8.73 or CVR<1.77 fetus,prenatal stable or even subsided absorption of the fetus.2.CVR≧1.77 or ratio of tumor volume to fetal femur length≧8.73 fetuses,prenatal tumor growth or even cause complications such as edema,the prognosis of children after birth is poor.The areas under the ROC curves of CVR,mass volume and fetal femur ratio were both 0.84,so they both predicted the same value of CCAM prognosis.3.CCAM III type postpartum mass disappearance of possibility.