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Tumor volume to fetal weight ratio (TFR) > 0.12 before 24 weeks has been associated with poor perinatal outcomes in fetuses with sacrococcygeal teratoma (SCT) but is not universally accepted. We evaluated the predictive value of TFR in our large cohort of fetuses with SCT.
Retrospective, single-center, cohort review of fetuses evaluated for SCT from 1997-2015. Patients who chose termination of pregnancy (TOP), delivered elsewhere, or had their initial evaluation > 24 weeks were excluded. Outcomes were compared in fetuses with TFR ≤ vs > 0.12. Poor outcome was defined as intrauterine fetal demise, neonatal demise, fetal deterioration warranting open fetal surgery, and fetal deterioration warranting delivery prior to 32 weeks.
140 pregnancies were confirmed to have SCT. 28 chose TOP, 13 delivered elsewhere, and 40 had their initial evaluation > 24 weeks. 59 fetuses with TFR at ≤ 24 weeks were stratified into two groups based on TFR (table). Fetuses with TFR > 0.12 were more likely to have a poor perinatal outcome compared to those with TFR ≤ 0.12 (24/32 vs 3/27; p<0.01). The sensitivity, specificity, positive predictive value, and negative predictive value of TFR > 0.12 in predicting poor outcome was 88.9%, 75.0%, 75.0% and 88.9%, respectively.
This is the largest single-center study to date and supports the use of TFR > 0.12 at ≤ 24 weeks to risk stratify fetuses with SCT. This information is useful in counseling and in forming surveillance programs for these highest risk fetuses.