Nadia Safa1, Natalie Yanchar2, Pramod Puligandla1, Maida Sewitch3, Robert Baird4, Mona Beaunoyer5, Andreana Butter6, Niamh Campbell7, Rati Chadha8, Christopher Griffiths9, Sarah Jones6, Manvinder Kaur10, Annie Le-Nguyen5, Ahmed Nasr10, Nelson Piché5, Hannah Piper4, Pascale Prasil11, Rodrigo Romao7, Lisa VanHouwelingen9, Paul Wales12, Elena Guadagno1, Sherif Emil13. 1. Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada. 2. Division of Pediatric Surgery, Alberta Children's Hospital, University of Calgary,Calgary, Alberta, Canada. 3. Department of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine and Health Sciences,Montreal, Quebec, Canada. 4. Division of Pediatric Surgery, Children's Hospital of British Columbia, University of British Columbia, Vancouver, British Columbia, Canada. 5. Division of Pediatric Surgery, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada. 6. Division of Pediatric Surgery, Children's Hospital London Health Sciences Centre, Western University, London, Ontario, Canada. 7. Division of Pediatric Surgery, IWK Health Sciences Centre, Dalhousie University,Halifax, Nova Scotia, Canada. 8. Division of Maternal Fetal Medicine, University of Calgary, Calgary, Alberta, Canada. 9. Division of Pediatric Surgery, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada. 10. Division of Pediatric Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada. 11. Division of Pediatric Surgery, Centre Hospitalier de l'Universite Laval, Quebec, Quebec, Canada. 12. Division of Pediatric General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. 13. Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada. Electronic address: sherif.emil@mcgill.ca.
Abstract
PURPOSE: The origin of congenital abdominal cysts in the female fetus often dictates management. While most arise from the ovary and are often managed non-operatively, some are non-ovarian and are frequently removed. We analyzed a national sample of female infants with congenital abdominal cysts to elucidate prenatal and postnatal factors associated with the diagnosis of a non-ovarian cyst. METHODS: A retrospective cohort study of female infants who were prenatally diagnosed with abdominal cysts between 2013 and 2017 at 10 Canadian pediatric surgical centres was performed. Clinical characteristics, pre- and postnatal sonographic findings, and cyst trajectories were compared between patients with proven ovarian etiology and those with cysts arising from other organs. RESULTS: Of 185 infants with prenatally diagnosed abdominal cysts, 22 (12%) were non-ovarian, five of which had clear non-ovarian organ of origin on prenatal ultrasound. Comparison of the other 17 cysts with 163 congenital ovarian cysts showed the following factors to be associated with a non-ovarian origin: earlier gestational age at diagnosis (23.5 vs 33.5 weeks, p <0.001), smaller diameter on first prenatal ultrasound (15.8 vs. 39.7 mm, p <0.001), change in sonographic character from simple to complex (87% vs 22%, p <0.001), and postnatal sonographic characteristics of complex cyst (87% vs. 48%, p = 0.004). CONCLUSION: Clear organ of origin, diagnosis earlier in gestation, smaller initial prenatal cyst diameter, and sonographic cyst character change differentiate congenital non-ovarian cysts from their ovarian counterparts. These characteristics may be used to guide diagnosis and management.
PURPOSE: The origin of congenital abdominal cysts in the female fetus often dictates management. While most arise from the ovary and are often managed non-operatively, some are non-ovarian and are frequently removed. We analyzed a national sample of female infants with congenital abdominal cysts to elucidate prenatal and postnatal factors associated with the diagnosis of a non-ovarian cyst. METHODS: A retrospective cohort study of female infants who were prenatally diagnosed with abdominal cysts between 2013 and 2017 at 10 Canadian pediatric surgical centres was performed. Clinical characteristics, pre- and postnatal sonographic findings, and cyst trajectories were compared between patients with proven ovarian etiology and those with cysts arising from other organs. RESULTS: Of 185 infants with prenatally diagnosed abdominal cysts, 22 (12%) were non-ovarian, five of which had clear non-ovarian organ of origin on prenatal ultrasound. Comparison of the other 17 cysts with 163 congenital ovarian cysts showed the following factors to be associated with a non-ovarian origin: earlier gestational age at diagnosis (23.5 vs 33.5 weeks, p <0.001), smaller diameter on first prenatal ultrasound (15.8 vs. 39.7 mm, p <0.001), change in sonographic character from simple to complex (87% vs 22%, p <0.001), and postnatal sonographic characteristics of complex cyst (87% vs. 48%, p = 0.004). CONCLUSION: Clear organ of origin, diagnosis earlier in gestation, smaller initial prenatal cyst diameter, and sonographic cyst character change differentiate congenital non-ovarian cysts from their ovarian counterparts. These characteristics may be used to guide diagnosis and management.