Superior mesenteric artery (SMA) syndrome, or Wilkie syndrome, is a rare cause of small bowel obstruction due to compression of the duodenum between the SMA and aorta. Patients most at risk of SMA syndrome include those with rapid weight loss due to a variety of conditions including chronic illness, malignancy, trauma, HIV, eating disorders, substance abuse, or bariatric surgery. Characteristic radiologic findings include an aortomesenteric angle less than 25 degrees and an aortomesenteric distance of less than 8 mm. Symptoms are typically postprandial and notably include abdominal fullness, voluminous emesis, and abdominal pain. Here we present a case of SMA syndrome in a 19-year-old cachectic female who initially presented with sudden-onset nausea, vomiting, and severe abdominal pain. Imaging revealed a severely distend stomach and proximal duodenum with a transition point in the third portion of the duodenum consistent with SMA syndrome. Her symptoms resolved with nasogastric decompression in addition to fluid and electrolyte management. She later endorsed restrictive eating patterns consistent with anorexia nervosa as well as methamphetamine use for weight loss. She underwent close outpatient follow-up for her anorexia nervosa and substance abuse.

S15cohorts. Median overall survival was 9.56 months in the CPX-351 arm and 5.95 months in the 7+3 arm (hazard ratio, 0.69 [95% CI, 0.52-0.90]; 1-sided P = 0.003). By 2 years, 84% of patients in the 7+3 arm had died versus 67% in the CPX-351 arm. Thus, on average, for every 6 patients treated with CPX-351, 1 death would be prevented over 2 years compared with 7+3 (1/(0.84 -0.67)). The CPX-351 safety profile was consistent with the known profile of 7+3. ConCluSionS: CPX-351 improved survival versus 7+3, with an associated NNT of 6 to prevent 1 death at 2 years, supporting the treatment benefit of CPX-351 in adults with newly diagnosed, tAML/AML-MRC.

Background: Current NCCN guidelines for early stage breast cancer (Stage I and II) do not recommend routine systemic imaging in the absence of symptoms or abnormal labs suggestive of distant metastasis. This study aims to determine the frequency and appropriateness of these imaging studies performed, its impact on staging and the factors that influence physicians in ordering these imaging studies. Methods: Patients with stage I and II breast cancer at initial presentation were retrospectively identified between years 2011-2015 from the tumor registry. Charts were reviewed to determine patients who got systemic imaging (CT scan, non-breast MRI, bone scan or PET scan) within 6 months of diagnosis. Provider notes and laboratory data were analyzed to establish the appropriateness of ordered imaging studies and if the imaging altered the stage. For each patient in the study, age at diagnosis, the grade of the breast tumor, hormonal receptor status and HER-2 status was documented. Statistical analysis was done using appropriate tests. Results: A total of 1067 patient charts were screened, of which 882 were identified for inclusion in the study (544 stage I, 338 stage II). Amongst the cohort, 18.57% (101) of patients with stage I and 50.89% (172) of patients with stage II cancer received imaging studies within the first 6 months of diagnosis. Only 12.68% (69) of stage I patients and 18.24% (62) of stage II patients were judged appropriate for imaging based on symptoms and lab results suggesting metastasis. In the imaged cohort of Stage I patients, only 4.35% (3) of the appropriately imaged group and 13.33% (4) of the inappropriately imaged group had a change in stage. Similarly, in the Stage II cohort, only 4.84% (3) of the appropriately imaged group and 8.18% (9) of the inappropriately imaged group saw a change in state. The difference in stage change in the appropriately and inappropriately imaged groups was not statistically significant. (p = 0.11 for Stage I, p=0.41 for Stage II). Only 5.9% of Stage I and 2.9% of Stage II imaged patients changed to stage IV. Grade 1 patients were less likely to receive systemic imaging than grade 2 and 3 patients ((p <0.001). Similarly, the difference in imaging rates ordered in patients with ER and/or PR negative status versus ER and PR positive status was significant (p=0.0004). Triple negative (p <0.001) status and age≤ 50 years were statistically significant predictors of patients receiving imaging (p = 0.014). HER-2 status alone was not a significant predictor of getting imaged (p= 0.527). Conclusions: We performed the first ever study to investigate a correlation between the appropriateness of ordered imaging studies in early stage breast cancer and its ability to detect a change in stage. Distant metastasis identification among stage I & II patients was extremely rare among both appropriately and inappropriately imaged groups. Our findings suggest a wide prevalence of inappropriately ordered imaging studies in Stage I and II breast cancer as well as limited utility for even appropriately ordered ones. Further, other factors such as grade of the tumor, ER/PR/HER2 status and age were found to be statistically significant predictors of whether patients received imaging studies. Citation Format: Gaba AG, Kraft R, Stjern BK, Monu M, Gunderson MA, Hanish C, Samreen A, Paladugu G. Systemic imaging fails to detect metastasis in early stage breast cancer [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 P1-01-01.

identified across US, Europe and Asia. The reported prevalence of NAFLD among the general population ranged between 22%-37% (US: 22%-32%; Europe 29-37%; Asia: 29.7%). Biopsy-confirmed NASH was reported between 16%-70% among the NAFLD population (US: 42-68%; Europe 16-45%; Asia: 70%). Two US studies reported the prevalence of NASH amongst the general population (0.05%-0.7%) using ICD-9 (571.8)/10 codes connected to NASH, as a proxy. Among the identified studies, a variety of comorbidities were reported in the study populations; diabetes, obesity, hypertension. The reported prevalence of NASH amongst type 2 diabetic patients and obesity patients, ranged between 57%-64% and 14%-47%, respectively. ConCluSionS: There is vast variability in the reported prevalence of NAFLD/NASH globally, however the findings are comparable to recently published meta-analyses. Although biopsy is considered the gold standard diagnosis for NASH, its limited use owing to associated procedural risks may not give us the true prevalence of NASH. Therefore, there is a need to achieve consensus in terminology, disease definition and diagnostic methods to better determine the true prevalence of the disease.