Differences In Margins Research Articles

Comparison of BillrothI, BillrothII, and Roux-en-Y Reconstruction After Totally Laparoscopic Distal Gastrectomy: A Randomized Controlled Study.

This study aimed to explore the efficacy of delta-shaped BillrothI anastomosis in totally laparoscopic distal gastrectomy for digestive tract reconstruction, and provide clinical data for determining the most appropriate digestive tract reconstruction method after distal gastrectomy. This was a prospective randomized controlled study. A total of 180 patients were randomly and prospectively selected from Renmin Hospital of Wuhan University by random number table. These patients were randomly divided into three groups: BillrothI group, BillrothII group, and Roux-en-Y (RY) group. There were significant differences in resection margin, blood nutrition, and the number of postoperative complications among these three groups (P<0.05). Furthermore, the resection margin, blood nutrition status, and immunization of patients in these three groups were determined. Compared to the other groups, the RY group was better in terms of hematologic status, immunological index, and postoperative complications. Delta-shaped BillrothI anastomosis in totally laparoscopic distal gastrectomy for digestive tract reconstruction is simple and easy to perform, and has an advantage in postoperative gastrointestinal function recovery. RY reconstruction is superior to BillrothI and BillrothII in terms of postoperative complications.

915 A Comparison of Endoscopic Submucosal Resection (EMR) vs. Endoscopic Submucosal Dissection (ESD) on Histologic Margins and Pathologic Evaluation for Endoscopically Managed Early Esophageal Adenocarcinoma

INTRODUCTION: Accurate histologic determination is important to determine the completeness of endoscopic resection for esophageal adenocarcinoma (EAC) and gauge risk of recurrence. EMR and ESD are both endoscopic resection techniques used for the treatment of early EAC. ESD advocates believe ESD specimens allow for more precise histopathologic analysis than EMR, but this has never been proven. We aim to determine the effect of EMR vs ESD techniques on histologic analysis in endoscopically treated early EAC. METHODS: This is a retrospective, single center study of EMR and ESD resection specimens with pathologic confirmation of HGD or T1 EAC between 1/15-12/18. Lesions with suspected invasion into the muscularis mucosa or beyond (T2 carcinoma or higher) were excluded. Endoscopic and histologic characteristics were collected. Pathology slides were re-analyzed by a blinded GI pathologist for typical pathologic features. RESULTS: 52 patients with early EAC were analyzed (23 ESD;29 EMR) [Table 1]. ESD-resected tumors were larger compared to those resected by EMR (20 mm [20.0, 28.0] vs 11 mm [9.0, 13.0], P &lt; 0.001) [Table 2]. As per Table 3, EMR specimens were more likely to have positive lateral margins compared to ESD (38% vs 13%, P &lt; 0.005) and have lower confidence in determining lateral margins. Reasons for lower confidence in the EMR group included cautery artifact (37.9%) and difficulty in orientation (20.7%). When accounting for differences in specimen thickness, EMR had a higher percentage of cauterized tissue per total tissue thickness (11.8% vs 3.9%, P &lt; 0.001). EMR specimens had cautery effect abutting the lesion while ESD did not (0 μm vs 2259 μm distance of lesion from nearest cautery, P = 0.001). Cautery effect was more likely to interfere with margin evaluation in EMR (38% vs 13%, P = 0.04). ESD specimens were well-oriented compared to EMR (P = 0.011). EMR and ESD had no difference in positive vertical margins (7% vs 9%, P = 0.33), lymphovascular invasion (P = 0.11), or submucosal invasion (P = 0.62). CONCLUSION: Cautery effect and the inability to orient the specimens appropriately play a role in limiting the evaluation of EMR specimens. EMR and ESD had similar rates of positive vertical margins but rates of positive lateral margins were significantly higher in EMR, despite a smaller lesion size resected with EMR. We postulate that this is a limitation of EMR technique and there is a certain lateral size that is unsuitable for EMR as it may not be able to resect enough of a “normal” margin to the tumor compared to ESD.

High-frequency ultrasound features of basal cell carcinoma and its association with histological recurrence risk.

Background:Due to advances in high-frequency ultrasound technology, it is easier to detect fine structures of skin lesions. The aim of this study was to examine the ultrasonographic features and use recurrence risk stratification to assess the diagnostic performance of pre-operative ultrasound examination of basal cell carcinoma (BCC).Methods:This was a retrospective study. Forty-six BCC lesions underwent pre-operative ultrasound examination using 50- and 20-MHz probes. Ultrasonographic shape, margin, internal echoes, hyper-echoic spots, posterior echoes, and depth of the lesion were evaluated and correlated with the risk of recurrence based on histological features.Results:Forty-two patients had 46 skin lesions in total. The high-risk (n = 6) and low-risk (n = 40) groups exhibited considerable overlap in the ultrasonographic manifestations and no significant difference in margin (χ2 = 3.231, P = 0.072), internal echo (χ2 = 1.592, P = 0.207), or posterior echo (P = 0.169). However, high-risk BCCs tended to be irregular in shape than low-risk lesions (χ2 = 4.313, P = 0.038). Both types presented hyper-echoic spots (χ2 = 1.850, P = 0.174). Additionally, 78% of low-risk lesions were confined to the dermis (31/40), and 100% of high-risk lesions infiltrated into the sub-cutaneous tissue, resulting in a significant difference between the two groups (χ2 = 10.951, P = 0.001). Ultrasound detected sub-clinical lesions in five patients.Conclusions:High-frequency ultrasound can provide important information for pre-operative evaluation of risk in BCC foci and reveal hidden lesions. The technique may play a crucial role in guiding therapeutic options for BCC.

Community Health Centers (CHCs) Under Environmental Uncertainty: An Examination of the Affordable Care Act of 2010 and Early Medicaid Expansion on CHC Margin

AbstractNonprofit community health centers (CHCs) are the largest subset of safety net clinics in the United States and, in many vulnerable and underserved areas, act as the only provider of vital health services in the community. The expansion of Medicaid provision under the Affordable Care Act of 2010 led to a fundamental change in the core client demographics of CHCs, with higher income thresholds and single childless individuals now eligible for Medicaid. This expansion of the Medicaid population creates both opportunities and threats that may impact CHCs’ long term financial sustainability. Accumulating reserves through positive net margins is a managerial tactic that nonprofits can utilize to buffer against environmental uncertainty. This study utilizes data from IRS Form 990s, American Community Survey, HRSA grantee lists, and the Area Resource File to model the differences in net margins between CHCs in early Medicaid expansion and non-expansion states from 2008–2012. Results show higher margins for CHCs in early expansion states compared to non-expansion states, even after accounting for organizational and environmental covariates. CHCs who are HRSA grantees are associated with positive margins whereas those relying more heavily on program revenue show negative margins. Further, CHCs located in counties with higher percentages of persons in poverty also demonstrate reduced margins. This exploratory study contributes to the nonprofit finance literature by highlighting the importance of incorporating contextual variables to deepen our understanding of changes in nonprofit financial health.

The oncological outcome and influence of neoadjuvant chemotherapy on the surgery in the resectable and locally advanced oral squamous cell carcinoma.

AimThe role of neoadjuvant chemotherapy (NCT) in the treatment of advanced oral squamous cell carcinoma (OSCC) is still controversial. Especially, there are still few studies investigating the influence of NCT on the following surgery. In this retrospective single-center attended cohort study, we investigated the oncological effect of NCT and its influence on the following surgery in patients with resectable locally advanced OSCC.MethodThe clinical data of 88 patients with locally advanced but resectable OSCC (T3/4) were reviewed retrospectively. NCT plus conservative surgery and radical surgery were compared. Five-year disease-specific survival (DSS) was observed as the main endpoint.ResultsAmong 88 patients enrolled in this study, 56 patients received upfront radical surgery (non-NCT group) and 32 patients received NCT followed by surgery (NCT group). The patients in the non-NCT group had a statistically better DSS than the patients in the NCT group (P=0.041). Twenty-one out of 32 (65.6%) patients who received NCT were good responders including two patients (6.2%) had a complete response and 19 patients (59.4%) had a partial response. There was no statistical difference between good and poor responders in 5-year DSS (P=0.823). Eleven patients (34.4%) had conservative surgery without flap reconstruction and 21 patients had radical surgery with flap reconstruction after NCT. No statistical difference in surgical margins was found between the two types of surgery (P=0.519). There was also no statistical difference in 5-year DSS between the two types of surgery (P=0.652).ConclusionNCT plus surgery could not improve survival compared with upfront surgery. NCT could modify the surgical extent but would not affect the surgical margins. This conclusion should be explained cautiously, and randomized clinical trials with large sample size were needed to further answer the question.

Diagnostic performance of ultrasound-based risk stratification systems for indeterminate thyroid nodules: comparison of the 2015ATA guidelines with the 2016 KTA/KSThR and 2017ACR guidelines

Objective: To evaluate the diagnostic value of the 2015ATA, 2017ACR and 2016KTA/KSThR ultrasound model for indeterminate thyroids nodules. Method: Four hundred and sixty-four patients with thyroid nodules that were initially diagnosed as indeterminate thyroids nodules by fine needle aspiration(FNA) cytology were included in this study. The clinical data and two-dimensional ultrasonographic features were compared between the benign and malignant nodules. The two-dimensional ultrasound images of all nodules were sorted by the 2015ATA, 2017ACR and 2016KTA/KSThR guideline ultrasound model grading criteria, and the malignant risk of different grading were calculated. In order to calculate the diagnosis and other indicators, the optimal threshold drawing from ROC curve was drawn to obtain the cut-off value of 2015ATA, 2017ACR and 2016KTA/KSThR. Result: ①There was no significant difference in age, sex and nodule size between benign and malignant nodules(P>0.05), and there also was no significant difference in irregular margin, microcalcification between benign and malignant nodules.②The sensitivity of the 2015ATA ultrasound model was 87.9%, slightly lower than that of the 2016KTA/KSThR and 2017ACR guidelines(P>0.05).The specificity of 2015ATA was 63.9%, which was significantly higher than that of 2016KTA/KSThR and 2017ACR guidelines(P<0.05). There was no significant difference between 2015ATA ultrasound model and 2016KTA/KSThR guide ultrasound for the accuracy(P>0.05), but the accuracy of 2015ATA ultrasound model was significantly higher than that of 2017ACR guide(P<0.05).③The area under the curve of 2015ATA was slightly lower than that of 2016KTA/KSThR(0.889 VS 0.902, P>0.05) and significantly higher than that of 2017ACR(0.889 VS 0.854, P<0.05). Conclusion: 2015ATA has high specificity and accuracy and moderate sensitivity for the diagnosis of benign and malignant indeterminate thyroids nodules, which is helpful for the clinical evaluation and management of such nodules.

Analysis of Clinical Efficiency and Safety of Laparoscopic Anus-Conserving Operation for Ultralow Rectal Cancer

To explore the efficiency and safety of laparoscopic anus-conserving operation for ultralow rectal cancer, we retrospectively reviewed 236 patients with ultralow rectal cancer who underwent laparoscopic anus-conserving operation (experimental group, n = 124) or conventional open surgery (control group, n = 112). Operation-related indexes, pathological results of mesentery, incidence rates of postoperative complications, anus preservation rates, anal sphincter controllability after surgery, and survival rates of the first, second, and third years after operation were compared between the two groups. The amount of intraoperative bleeding, first postoperative exhaust time, abdominal drainage, pain score, and hospital stay in the experimental group were significantly less than those in the control group (P < 0.05). There were no significant differences in the postoperative circumferential resection margin, distal resection margin, number of dissected lymph nodes, successful resection rate, and quality of mesorectum between the two groups (P > 0.05). The total incidence rate of postoperative complications, anal sphincter controllability, and survival rates after surgery were similar between the two groups (P > 0.05). The anus preservation rate of the experimental group (84.7%) was significantly higher than that of the control group (69.6%) (P < 0.05). Laparoscopic anus-conserving operation is effective and safe in treatment of patients with ultralow rectal cancer, which has advantages such as small trauma, less intraoperative bleeding, short hospital stay, rapid recovery, a low incidence rate of postoperative complications, and a high anus-preserving rate, so it is worthy of clinical application.

Variant hepatic arterial anatomy encountered during pancreatoduodenectomy does not influence postoperative outcomes or resection margin status: A matched pair analysis of 105 patients.

Anatomic vascular abnormalities of the hepatic arteries are frequent. The aim of the study was to analyze the influence of hepatic arterial variations on postoperative morbidity and resection margin status after pancreatoduodenectomy (PD). Patients who underwent PD over a 7-year period (2010-2017) were included in the study. Patients with variant hepatic arterial anatomy were matched 1:2 for age, sex, ASA score, and histology. A total of 232 patients underwent PD. Variant hepatic arterial anatomy was found in 35 (15.1% of the total patient population). The most common variation was an accessory right hepatic artery (8.19%) and a replaced right hepatic artery (5.60%) arising from the superior mesenteric artery. These 35 patients were compared with 70 patients with no hepatic artery variations. Postoperative surgical complications occurred in 12.1% and 26.5% (P = 0.08) and in-hospital mortality was 6% and 5.4% ( P = 0.99) between patients with and without variant hepatic arteries. There was no difference in positive resection margins (R1) (18.2% vs 20.5%, P = 0.99) between the two groups. An aberrant hepatic artery does not increase morbidity or R1 resection in patients undergoing PD.

Multi-objective simulation and optimisation of dairy sheep farms: Exploring trade-offs between economic and environmental outcomes

A decision support tool for sheep farming systems (PASTOR-DSS) was developed to investigate trade-offs between economic and environmental objectives on Spanish dairy sheep farms. The tool combines a hierarchical stochastic simulation model at three levels with a multi-objective optimisation procedure based on genetic algorithms. The first level of simulation includes rumen, reproduction and nutrient balance submodels. These three submodels are integrated into an animal model, which constitutes the second level. The third level is the farm, which includes the flock, the feeding and reproductive management, the availability of feeding resources, and the farm economics. The multi-objective genetic algorithm applies to the farm level. The tool was validated for the different levels of simulation, with outputs having an acceptable level of accuracy and representing correctly the links between feeding and reproduction. The tool was used to optimise the Latxa breed farming systems of the Basque Country (Spain). Two farm types were simulated: a COAST farm located in low-altitude Atlantic conditions and longer grazing period, and the INLAND farm located in mountain areas with a shorter grazing period. The optimisation provided a set of optimal solutions with different economic and environmental (N excretion) performances. The optimal solutions increased the financial margin over feed costs in both farms (+24% and + 22% for COAST and INLAND, respectively). The final space of solutions showed a clear trade-off between the economic and environmental performance (nitrogen excretion). The difference in the financial margin over feed costs between the solutions could be interpreted as the opportunity cost of greening in policy design, i.e., the payment that farmers should receive to change their farming methods to reduce nitrogen pollution.

Abstract P6-19-03: The role of lumpectomy and radiation therapy in men 70 years of age and older with early breast cancer on hormone therapy: A NCDB analysis

Abstract Background: Current consensus guidelines for the treatment of male breast cancer are driven by female-only clinical trials despite data suggesting distinct biologic, clinicopathologic, and prognostic differences between male and female breast cancer patients. This includes a recent retrospective multicenter analysis showing greater overall survival among male breast cancer patients who underwent lumpectomy with radiation therapy (RT), compared to total mastectomy or lumpectomy alone. In light of these findings and the CALGB 9343 trial performed in women, we sought to evaluate if survival was also equivalent in men ≥70 years old with early stage breast cancer treated with hormone therapy and lumpectomy with or without radiation therapy (RT), as shown in women. Methods: We performed a retrospective analysis of 752 stage I (T1N0M0), estrogen receptor (ER) positive male breast cancer patients ≥70 years of age who were treated with hormone therapy and underwent lumpectomy with or without RT or total mastectomy (without RT) from the National Cancer Database (NCDB) between the years 2004 to 2014. Chi-squared, Kruskal-Wallis, and analysis of variance tests were used to compare demographic and clinicopathologic differences between groups. Multivariable Cox proportional hazards regression analysis was used to compare overall survival between treatment groups, controlling for demographic and clinicopathologic differences. Results: Most patients underwent total mastectomy (67.4%), with only 32.6% treated with lumpectomy. Of those who underwent lumpectomy, 72.6% (n=178) underwent adjuvant RT. There were significant differences in age, tumor size, histology, grade, surgical margins, nodal surgery, and chemotherapy between patients who underwent lumpectomy without RT, lumpectomy with RT, and total mastectomy (p&amp;lt;0.05). Lumpectomy without RT patients were older (78.9 vs. 76.0 &amp; 76.9 years, p&amp;lt;0.01), more frequently presented with invasive ductal carcinoma (77.6% vs. 71.3% &amp; 85.4%, p&amp;lt;0.0001), and less frequently underwent axillary nodal surgery including sentinel lymph node biopsy (71.7% vs. 91.6% &amp; 94.9%, p&amp;lt;0.0001) compared to lumpectomy with RT and total mastectomy patients. In multivariate analysis, there were no significant differences in overall survival for lumpectomy without RT, lumpectomy with RT (HR 0.71, 95%CI 0.39-1.27, p=0.25), and total mastectomy alone (HR 0.92, 95%CI 0.55-1.56, p=0.76). Older age, higher Charlson-Deyo comorbidity scores, and poorly differentiated tumors were associated with poorer overall survival, while treatment at an academic/research center was associated with improved overall survival (p&amp;lt;0.05). Conclusion: In this national sample of elderly ER positive male breast cancer patients with early disease on hormone therapy, lumpectomy alone was associated with equivalent survival compared to lumpectomy with RT and total mastectomy alone. These results suggest that breast conserving surgery without radiation therapy is appropriate for this subset of male breast cancer patients and greater adoption by breast surgeons should be considered. Citation Format: Bateni SB, Arora M, Daly ME, Bold RJ, Canter RJ, Sauder CA. The role of lumpectomy and radiation therapy in men 70 years of age and older with early breast cancer on hormone therapy: A NCDB analysis [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-19-03.

Wine tourism as an increasingly valuable revenue stream of a winery's business model

Nowadays, wine tourism belongs to the key business activities of a winery. It represents a diversification tool of a typical production company. The research paper aims to explore the relationship between wine tourism and business model parameters according to financial and production performance of a winery. The results of the parametric Independent sample t –test reveal that there is no difference in revenue, profit or gross margin between two groups of wineries with or without wine tourism activities. But the analysis gave proof about the difference in a number of revenue streams, key, and additional business activities. The effect size r for t- test was also calculated. Measuring the association between key performance indicators and wine tourism activities reveals the dependency with the number of revenue streams of a winery. Additional business activities are the most relevant parameter to perform better results in wine tourism.

Comparative Analysis of Improved Maize (&amp;lt;i&amp;gt;Zea mays&amp;lt;/i&amp;gt; L.) Seeds Adoption on Smallholder Farmers’ Performance in Fako Division, South West Region, Cameroon

This paper describes the socio-economic characteristics of smallholder adopters and non-adopters of improved maize seeds; compares the physical productivity (yield) level of improved maize seed adopters’ and non-adopters’; determines the differences in cost, revenue and gross margin between smallholder adopters and non-adopters of improved maize seeds in Fako division. To achieve these objectives, data were collected from 150 adopters and 150 non-adopters of improved maize seeds and analyzed with the use of descriptive and inferential statistical tools. The results of the study show that maize production is dominated by educated married women (76.67%) with average age of 48 years for adopters and 51 years for non-adopters of improved maize seeds in Fako Division. Results also show that the average family size is 4 persons who rely on agricultural production as their main source of income and have been farming for an average of 17 years for adopters and 21 years for non-adopters of improved maize seed although without any training in maize production. The result of physical productivity (yield) revealed the existence of productivity gap between adopters and non-adopters with a significant (P < 0.001) positive difference of 297.7kg, in favour of adopters. In the same light, a difference in gross margin of 44,329.28 FCFA (Franc de la Communaute Financiere l’Afrique) was recorded in favour of adopters of improved maize seeds. Therefore, improved maize seed can be considered as one of the empowerment tools with the potential of boosting farm productivity, increasing farmers’ income, increase food security and welfare of farmers in the long run.

Transanal versus transabdominal specimen extraction in laparoscopic rectal cancer surgery: a retrospective analysis from China.

IntroductionComparison of transanal specimen extraction (TSE) and transabdominal specimen extraction (TASE) in laparoscopic rectal surgery is still sparsely reported. Trauma, pain, scarring, and bad psychological suggestion have long been considered an inevitable outcome of surgery. For laparoscopic rectal cancer surgery, whether TSE or TASE is beneficial in terms of technical platforms, indications, contraindications, technical requirements for aseptic operation, tumor-free operation, prevention and treatment of complications still has not reached a unified consensus and standards. Recently, comparison of TSE and TASE in laparoscopic rectal surgery has still been sparsely reported.AimIn this study, we retrospectively analyzed the short-term outcomes of TSE and TASE in laparoscopic rectal surgery in a single institution in southern China.Material and methodsPatients who underwent laparoscopic radical rectal cancer surgery using either TSE or TASE were recruited. Data, including patient demographics, perioperative and postoperative variables, were analyzed retrospectively.ResultsSixty-seven patients were included in this study. Thirty patients underwent TSE and 37 patients underwent TASE. The two groups were similar in demographics and tumor characteristics. Postoperative complications were similar in both groups, except that wound infection was lower for the TSE group (p = 0.122). The TSE group had a better cosmetic result with no abdominal incision and no differences in circumferential margins, distal resection margins or completeness of total mesorectal excision.ConclusionsLaparoscopic TSE is recommended in the treatment of rectal cancer with similar oncologic outcomes compared with conventional TASE. It is mini-invasive surgery and has the advantage of better cosmetic results. There is a need for further randomized studies to refine the applicability of laparoscopic TSE in rectal cancer.

Sustainable Growth: Grow and Broke Empirical Study on Manufacturing Sector Companies Listed on the Indonesia Stock Exchange

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The effect of seeding rate on radiation interception, grain yield and grain quality of autumn sown oats

Abstract Oats are attracting increasing interest as a result of their nutritional and health benefits but increasing financial pressures are forcing growers to review all inputs including seed costs. High seeding rates are traditionally used for autumn sown oats in Ireland but it may be possible to use lower seed rates with resultant savings if oat plants can compensate for lower plant populations. A series of experiments were conducted in Ireland from 2015 to 2017 to investigate if lower seed rates could be used for autumn sown oats without compromising yield or quality. Experiments were conducted on both light and heavy soils at sites near Carlow in the centre of Ireland in which three oat varieties (Barra, Husky and Vodka) were grown at five seeding rates (100, 200, 300, 400 and 500 seeds/m2). Experiments were also conducted at Kildalton in the south east of Ireland in which the same three oat varieties were grown at five different seeding rates (125, 250, 375, 500 and 625 seeds/m2). Establishment decreased significantly with seeding rate. Oat plants at low plant populations developed additional grains primarily through an increase in the number of grains per panicle. At GS32, there was no significant difference in radiation interception between seeding rates from 200 seeds/m2 to 500 seeds/m2. The difference in yield between the lowest and highest seeding rate treatments was 1.1 t/ha at the Carlow sites and 0.7 t/ha at the Kildalton site. There were no significant difference in margin between seeding rate treatments at a grain price of €125/tonne. Grain quality was not affected by seeding rate. Autumn sown oats can compensate for low plant populations with the result that the seeding rates used in good sowing conditions can be reduced without any impact on margin or on grain quality.

The financial value of vascular surgeons as operative consultants to other surgical specialties

ObjectiveVascular surgeons provide assistance to other surgical specialties through planned and unplanned joint operative cases. The financial impact to the hospital of vascular surgeons as consultants in this context has yet to be quantified. We sought to quantify the financial value of services provided by consulting vascular surgeons in the performance of joint operative procedures, both planned and unplanned. MethodsHospital financial data were reviewed for all inpatient operative cases during a 3-year period (2013-2015). Cases in which a vascular surgeon provided operative assistance as a consultant to a nonvascular surgeon were identified and designated planned or unplanned. Contribution margin, defined as hospital revenue minus variable cost, was determined for each case. In addition, the contribution margin ratio (contribution margin divided by revenue) was determined for each cohort. Financial data for consulting cases was compared with all nonconsult cases. Data analysis was performed with nonparametric statistics. ResultsThere were 208 cases with a primary nonvascular surgeon that required a vascular co-surgeon during the study period, 169 planned and 39 unplanned. For comparison, 19,594 nonconsult cases of other surgical specialties were identified. The median contribution margin was higher for vascular surgery consult cases compared with nonconsult cases ($14,406 [interquartile range, $63,192] vs $5491 [interquartile range $28,590]; P = .002). The overall contribution margin ratio was higher for vascular surgery consult cases (0.41) compared with control nonconsult cases (0.35). There was no difference in contribution margin and contribution margin ratio between planned and unplanned vascular surgery consult cases. ConclusionsVascular surgeons provide essential operative assistance to other surgical specialties. This operative assistance is frequent and provides significant financial value, with high contribution margin and contribution margin ratio. Vascular surgeons, as consulting surgeons, enable the completion of highly complex cases and in this capacity provide significant financial value to the hospital.

Textural analysis on contrast-enhanced CT in pancreatic neuroendocrine neoplasms: association with WHO grade.

Grades of pancreatic neuroendocrine neoplasms (PNENs) are associated with the choice of treatment strategies. Texture analysis has been used in tumor diagnosis and staging evaluation. In this study, we aim to evaluate the potential ability of texture parameters in differentiation of PNENs grades. 37 patients with histologically proven PNENs and underwent pretreatment dynamic contrast-enhanced computed tomography examinations were retrospectively analyzed. Imaging features and texture features at contrast-enhanced images were evaluated. Receiver operating characteristic curves were used to determine the cut-off values and the sensitivity and specificity of prediction. There were significant differences in tumor margin, pancreatic duct dilatation, lymph nodes invasion, size, portal enhancement ratio (PER), arterial enhancement ratio (AER), mean grey-level intensity, kurtosis, entropy, and uniformity among G1, G2, and pancreatic neuroendocrine carcinoma (PNEC) G3 (p < 0.01). Similar results were found between pancreatic neuroendocrine tumors (PNETs) G1/G2 and PNEC G3. AER and PER showed the best sensitivity (0.86-0.94) and specificity (0.92-1.0) for differentiating PNEC G3 from PNETs G1/G2. Mean grey-level intensity, entropy, and uniformity also showed acceptable sensitivity (0.73-0.91) and specificity (0.85-1.0). Mean grey-level intensity was also showed acceptable sensitivity (91% to 100%) and specificity (82% to 91%) in differentiating PNET G1 from PNET G2. Our data indicated that texture parameters have potential in grading PNENs, in particular in differentiating PNEC G3 from PNETs G1/G2.

Friday, September 28, 2018 1:00 PM–2:30 PM abstracts: a new look at imaging: 205. Supine versus weight bearing MRI in the evaluation of patients with lumbar spondylolisthesis

BACKGROUND CONTEXT The severity of the slip in patients with spondylolisthesis is often evaluated with imaging studies, including MRI. One potential problem is the imaging being performed with the patient lying supine in the scanner, usually with a support under the legs. This creates imaging the spine in a somewhat unnatural and unloaded position. Use of upright MRI provides imaging in a weight bearing, normal position. PURPOSE The severity of the slip in patients with spondylolisthesis is often evaluated with imaging studies, including MRI. One potential problem is the imaging being performed with the patient lying supine in the scanner, usually with a support under the legs. This creates imaging the spine in a somewhat unnatural and unloaded position. Use of upright MRI provides imaging in a weight bearing, normal position. STUDY DESIGN/SETTING This was a prospective study performed in a spine specialty clinic. PATIENT SAMPLE MRIs in the supine and upright weight bearing positions were made on 28 patients with spondylolisthesis. OUTCOME MEASURES Measurements made for the current study included as the primary measure, the listhesis at level of the spondylolisthesis (difference in the inferior posterior margin of the superior vertebrae). Also analyzed were the vertebral body translation (difference in the location of the midpoint of the vertebral body), segmental angle (angle of the disc space at the level of the slip), and the overall lumbar lordosis (L1–L5). METHODS All scans were performed using the Esaote G-scan. This is an open scanner in which the table rotates with the patient on it, so the supine and upright weight bearing images (table rotated 84° vertically) were obtained during the same scanning session. The imaging parameters used for the study was the T2 fast spin echo sequence. MRIs from both positions were measured using semiautomated Q-Spine software in which each vertebral body from L1 to S1 is registered allowing various measurements to be made automatically. RESULTS In the weight bearing position, the mean listhesis value was 4.2mm, which was significantly greater than the value of 3.1mm recorded for the supine position (paired t -test p CONCLUSIONS There were statistically significant differences in the severity of listhesis, vertebral body translation, and lordosis when comparing MRI scans made in the supine and weight bearing positions. These results support that body position during MRI can effect the images. This may have implications on evaluating severity of spondylolisthesis.

MRI features of mucinous carcinoma and myxoidfibroadenoma of the breast

Objective To study the features of mucinous carcinoma and myxoidfibroadenoma of the breast on MRI. Methods Fourty patients with pure mucinous carcinoma and myxoidfibroadenoma confirmed by surgical pathology who underwent breast MRI from January 2010 to May 2017 in Tianjin Medical University Cancer Institute and Hospital were analyzed retrospectively, including 26 patients with mucinous carcinoma and 14 patients with myxoidfibroadenoma. By use of the Breast Imaging Reporting and Data System (BI-RADS) lexicon, an analysis of the shape, margin, infiltration to adjacent tissues, the lesion location, signal intensity in the T1WI and fat-suppressed T2WI, dark internal septation, the pattern of time-signal intensity curve (TIC),rim enhancement, delayed internal enhancement, the DWI signal and ADC values was performed. Qualitative data and quantitative data were compared with χ2 test and independent sample t test respectively. Results There were significant differences in the margin, dark internal septation, the lesion location, rim enhancement and delayed internal enhancement between mucinous carcinoma and myxoidfibroadenoma(P 0.05). Conclusion The combination of irregular margin, less frequent dark internal septation, rim enhancement in the early phase, delayed heterogeneous enhancement and the lesion location where was in the shallow layer of fibro-glandular tissue were significant findings for differentiation between mucinous carcinoma and myxoidfibroadenoma. Key words: Breast neoplasms; Mucinous carcinoma; Myxoidfibroadenoma; Magnetic resonance imaging

CT1a renal masses < 2 versus > 2 cm managed with Robotic Partial Nephrectomy: a propensity-score matched comparison of perioperative Outcomes

PurposeTo perform a single center evaluation comparing the perioperative, pathological and functional outcomes of robotic partial nephrectomy (RPN) for T1a renal masses < 2 cm vs T1a renal masses > 2 cm. Materials and MethodsPropensity score 1:1 matching of queried patients was performed from the institutional RPN database (January 2007 – January 2017) by age, sex, race, BMI, Charlson’s comorbidity Index, smoker status, diabetes, hypertension, hyperlipidemia, ASA score, eGFR, Chronic Kidney Disease stage and RENAL score. 524 patients were analyzed (262 < 2 cm vs 262 > 2 cm). Perioperative, pathological and functional outcomes were evaluated. ResultsSmaller renal masses (< 2 cm) had significantly lower operative time, blood loss, ischemia time (14.3 + 9.58 vs 21.5 + 9.51 minutes, p < 0.001) and intraoperative transfusions (0 vs 2.7%, p = 0.015). Moreover, superior early renal functional outcome as assessed by eGFR at first postoperative day (83.1 + 21.3 vs 76.6 + 22.0, p = 0.001), higher percentage of parenchymal preservation (89.9 + 9.45 vs 83.6 + 8.20%, p < 0.001) and a trend towards a lower rate of postoperative complications (13.5 vs 19.5%, p = 0.080) were found. Higher percentage of malignancies was found in larger tumors (74.8 vs 85.9%, p = 0.002), but no difference in positive surgical margins was recorded. ConclusionsRPN tends to be a low morbidity treatment modality for renal masses < 2 cm. Although active surveillance is a common option for such tumors, RPN remains an alternative for selected patients.