Concordance of MRI, CT, and Surgical Pathology in Prenatally Diagnosed Lung Lesions.

INTRODUCTION

This study quantified the concordance of pre- and postnatal imaging and pathology diagnoses of fetal lung lesions.

METHODS

This is a retrospective review of patients seen at a single fetal center from 2014 to 2024.

RESULTS

A total of 138 patients with prenatally diagnosed lung lesions were identified. Patients with an associated congenital diaphragmatic hernia (n = 7) and patients with neither postnatal imaging nor surgical pathology (n = 11) were excluded. Overall, 86.7% had postnatal imaging; of these, 79.8% had postnatal CT findings consistent with prenatal imaging. Overall, 68.3% had surgical resection at our institution. The remaining patients had surgery elsewhere or did not pursue resection of the lesion. Of those 82 patients, 90.2% had a pathologic diagnosis concordant with their prenatal MRI and 97.1% had a pathologic diagnosis concordant with postnatal CT. The most common case of discordance between pre- and postnatal imaging was bronchial atresia (71.4%, 15/21), which was originally called a CPAM/BPS/hybrid lesion on prenatal imaging. The most striking case of discordance between imaging and pathology was a pleuropulmonary blastoma initially called a CPAM on prenatal MRI.

CONCLUSION

Congenital lung lesions may evolve during pregnancy, highlighting the value of postnatal imaging to further characterize the lesions and assess the appropriateness of patients for surgical resection.