title: Tumor volume to fetal weight ratio as an early prognostic classification for fetal sacrococcygeal teratoma.
abstract: OBJECTIVE
  This study was designed to develop a prognostic factor for fetuses with sacrococcygeal teratoma (SCT) that may be useful to predict outcome and guide counseling early in pregnancy. We hypothesize that, in fetuses with SCT, the ratio of tumor size to estimated fetal weight in the second trimester predicts outcome.
  
  
  METHODS
  We retrospectively reviewed charts of all patients evaluated at our Fetal Center for SCT between 2004 and 2009. Estimated fetal weight and tumor volume were calculated based on prenatal ultrasound or fetal magnetic resonance imaging. Patients were stratified based on tumor volume to fetal weight ratio (TFR), and their outcomes were analyzed by Fisher's Exact test.
  
  
  RESULTS
  Tumor volume to fetal weight ratio before 24 weeks' gestation was predictive of outcome. Those with a TFR less than or equal to 0.12 (n = 5) had a significantly better outcome than patients with a TFR greater than 0.12 (n = 5, P < .05). All patients with poor outcomes had a TFR greater than 0.12 by 24 weeks' gestation. A TFR greater than 0.12 predicted poor outcome with 100% sensitivity and 83% specificity. All 4 patients who developed hydrops had a TFR greater than 0.12.
  
  
  CONCLUSIONS
  In our series of fetuses with SCT, TFR before 24 weeks' gestation correlates with outcome. This novel, prenatal diagnostic tool may be useful in prenatal counseling and for early identification of high-risk fetuses.
authors.affiliation: Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030, USA.
authors.forename: Manuel A
authors.initials: MA
authors.lastname: Rodriguez
authors.forename: Darrell L
authors.initials: DL
authors.lastname: Cass
authors.forename: David A
authors.initials: DA
authors.lastname: Lazar
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Cassady
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Moise
authors.forename: Anthony
authors.initials: A
authors.lastname: Johnson
authors.forename: Oren P
authors.initials: OP
authors.lastname: Mushin
authors.forename: Saif F
authors.initials: SF
authors.lastname: Hassan
authors.forename: Bella
authors.initials: B
authors.lastname: Belleza-Bascon
authors.forename: Oluyinka O
authors.initials: OO
authors.lastname: Olutoye
mesh_terms: D015331:Cohort Studies; D005260:Female; D005313:Fetal Death; D005315:Fetal Diseases / Q000175:diagnosis; D020567:Fetal Weight; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D011296:Prenatal Diagnosis / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012445:Sacrococcygeal Region / Q000000981:diagnostic imaging / Q000473:pathology*; D012680:Sensitivity and Specificity; D015996:Survival Rate; D013724:Teratoma / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology*; D013997:Time Factors; D047368:Tumor Burden; D016216:Ultrasonography, Prenatal / Q000379:methods