http://informahealthcare.com/jmf ISSN: 1476-7058 (print), 1476-4954 (electronic) J Matern Fetal Neonatal Med, Early Online: 1–9 ! 2015 Informa UK Ltd. DOI: 10.3109/14767058.2015.1059812 ORIGINAL ARTICLE Fetal intra-abdominal cysts: accuracy and predictive value of prenatal ultrasound Vincenzo Davide Catania 1 , Vito Briganti 1 , Vincenza Di Giacomo 2 , Vittorio Miele 2 , Fabrizio Signore 3 , Chiara de Waure 4 , Giovanna Elisa Calabro ` 4 , and Alessandro Calisti 1 1 Pediatric Surgery and Urology Unit, San Camillo Forlanini Hospital, Rome, Italy, 2 Radiology Department, San Camillo Forlanini Hospital, Rome, Italy, 3 Department of Obstetrics and Gynecology, San Camillo Forlanini Hospital, Rome, Italy, and 4 Department of Public Health, Section of Hygiene, Catholic University of the Sacred Heart, Rome, Italy Abstract Objective: The finding of a fetal intra-abdominal cyst is relatively common and it can be due to a wide variety of clinical conditions. The aims of this study were to determine the accuracy of the prenatal ultrasound (US) in identifying the etiology of fetal intra-abdominal cysts and to describe the neonatal outcomes. Methods: All cases of fetal intra-abdominal cystic lesion referred to our center between 2004 and 2012 were reviewed. Cysts of urinary system origin were excluded. Prenatal and postnatal data were collected. Our cohort was divided into subgroups according to the prenatal suspected origin of the lesion (ovarian, mesenteric, gastro-intestinal and other locations). For each subgroup, sensitivity, specificity, positive predictive value, false-positive rate and accuracy of fetal US were calculated. Results: In total 47 fetuses (10/37 M/F) were identified. The mean gestational age at the time of diagnosis was 33 ± 4.9 weeks. Our cohort comprised of 25 ovarian cysts (10 simplex and 15 complex), 3 GI duplication, 6 mesenteric lesions, 4 meconium pseudocyst and 9 lesions of other origin. Surgery was performed in 38 cases (81%) at birth. The prenatally established diagnosis was exactly concordant with post-natal findings in 34 cases (72.3%). Sensitivity, specificity, positive predictive value and false-positive rate of US were 88.1%, 95.5%, 71% and 5.4%, respectively. Long-term outcome was good in almost 90% of the cases. Conclusions: The etiology of fetal intra-abdominal cysts can be prenatally diagnosed in about 70% cases. Despite the high risk of surgery at birth, the long-term outcome was good in most of the cases. Keywords Fetal, intra-abdominal cyst, intra-abdominal mass, prenatal diagnosis, prenatal ultrasound History Received 14 October 2013 Revised 27 May 2015 Accepted 4 June 2015 Published online 28 July 2015 Introduction Among the recent advances in fetal diagnostic technologies the widespread use of modern ultrasound (US) has enabled more precise assessment and early identification of fetal abnormalities [1–4]. The prenatal diagnosis of intra- abdominal cystic lesions is relatively common [5]. They may either represent a normal structural variant or patho- logical entity that may require surgical intervention after birth [3]. Regardless of the underlying pathology, the most common sonographic presentation is that of a round, anechoic structure or variable size and position [5]. In clinical practice, these lesions are most frequently detected at the time of routine morphology scan at 18–20 weeks [4–6]. However, some notably ovarian cyst and gastrointestinal (GI) malfor- mation do not become apparent until the third trimester [4,5,7]. Additionally, some cysts may develop and then resolve during intrauterine life [6]. The diagnosis of a fetal intra-abdominal cyst might represent a diagnostic and man- agement dilemma due to the wide variety of potential diagnosis [4]. Excluding urinary origin, the most common etiologies of fetal intra-abdominal cysts are: ovarian cysts, GI cystic duplication, hepatic and biliary tree cysts, meconium pseudocysts, mesenteric cysts, adrenal cysts, splenic cysts and hydromtetrocolpos [5,8]. The differential diagnosis can be aided by knowledge of the sex of the fetus, the location, the appearance and the relationship with the adjacent structures of the cyst, as well as the prevalence of the various etiologies [2,3,5,9,10]. The most challenging problem is to decide which cases will be amenable to US monitoring, postnatal surgery or even prenatal invasive therapy [2,4]. Decision-making is usually based on the conclusions of multidisciplinary meet- ings and on the opinion of pediatric surgeon regarding Address for correspondence: Vincenzo Davide Catania, MD, Pediatric Surgery and Urology Unit, San Camillo Forlanini Hospital, Circonvallazione Gianicolense 87, Rome, Italy. Tel: +39 340 85 15 704, +39 06 58703278. Fax: +39 06 58704438. E-mail: vdcatania1985@gmail.com Downloaded by [Alessandro Calisti] at 08:24 10 August 2015