We would like to comment on the article by Calvert et al.1 This group presents data from a retrospective audit of 28 children who were antenatally diagnosed with congenital lung malformations. The authors recommend elective resection of all congenital lung malformations that persist beyond 1 year of age, although their data provide no evidence to support this argument. Over the years, several authors have suggested that congenital lung malformations detected antenatally pose a major risk to the child's health from infection, pneumothorax and malignancy. As a result, a prevailing view has emerged that all lesions should be resected, regardless of symptoms.
The Fetal Medicine Department, Leeds General Infirmary, Leeds, UK, provides a tertiary referral service for a region with around 50 000 births per annum. We see 5–10 new patients each year with antenatally diagnosed congenital lung malformations, which suggests an incidence of around 1 in 5000–10 000 births.
We followed up a cohort of >100 children with antenatally diagnosed congenital lung malformations. Around 10% of these children showed symptoms in the neonatal period and underwent surgery. During early childhood, about 5% of children developed lower respiratory tract infection and subsequently underwent surgery. The remaining are under follow‐up and remain symptom‐free.
The data presented in Calvert et al's audit do not support their conclusions, which are simply a reiteration of the advice of others. We are aware of reports of malignancy arising in congenital lung malformations. Given that these are single case reports or small series, the incidence of malignancy must be extremely small. We have not seen any instance in the children under follow‐up in the Leeds General Infirmary. If malignant degeneration is an intrinsic property of congenital lung malformations, then it is inherently illogical not to resect the disappearing lesions, which are detectable only postnatally on computed tomography. In addition, there is a case report of malignancy arising in the lung after resection of the cystic abnormality, which implies the need for long‐term follow‐up, regardless of whether surgery has been carried out.1
The natural history of congenital lung malformations detected antenatally is almost certainly not the same as the lung malformations, which present clinically in postnatal life. It is our opinion that infants are being submitted to lung resection unnecessarily.
Footnotes
Competing interests: None declared.
References
- 1.Calvert J K, Boyd P A, Chamberlain P C.et al Outcome of antenatally suspected congenital cystic adenomatoid malformation of the lung: 10 years' experience 1991–2001. Arch Dis Child Fetal Neonatal Ed 200691F26–F28. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Papagiannopoulos K, Sheppard M, Bush A.et al Pleuropulmonary blastoma: is prophylactic resection of congenital lung cysts effective? Ann Thorac Surg 200172604–605. [DOI] [PubMed] [Google Scholar]