BackgroundPast catheter-based and focused ultrasound renal denervation studies have indicated that procedure efficacy is related to the number of ablations performed or the amount of energy used for the ablation. This study extends those prior results and investigates energy level effects on the efficacy of MR guided focused ultrasound renal denervation performed in a porcine model.MethodsTwenty-four normotensive pigs underwent unilateral denervation at three intensity levels. The applied intensity level was retrospectively de-rated to account for variability in animal size. Efficacy was assessed through evaluating the norepinephrine present in the kidney medulla and through histological analysis. The treatment was performed under MRI guidance including pre- and post-procedure T1-weighted and quantitative T1 and T2 imaging. During treatment, the temperature in the near field of the ultrasound beam was monitored in real time with MR temperature imaging. Energy delivery in the regions surrounding the renal artery was independently confirmed through an invasive fiberoptic temperature probe placed in the right renal artery.ResultsAnimals that underwent denervation at a de-rated acoustic intensity of greater than 1.2 kW/cm2 had a significantly lower norepinephrine concentration in the kidney indicating successful denervation. Images obtained during the treatment indicated no tissue changes in the kidneys as a function of the procedure but there were significant T1 changes present in the right lumbar muscles, although only one animal had indication of muscle damage at the time of necropsy.ConclusionsWhile MR guided focused ultrasound renal denervation was found to be safe and effective in this normotensive animal model, the results indicated the need to incorporate patient-specific details in the treatment planning of MRgFUS renal denervation procedure.

PPV, and 89% (82-94) NPV. Detection of neuroendocrine tumors by FNA-EUS yielded 66% (47-87) sensitivity, 100% (97-100) specificity, 94% (71-99) PPV, and 97% (94-99) NPV. Detection of IPMN by FNA-EUS yielded 59% (43-74) sensitivity, 100% (98-100) specificity, 100% (87-100) PPV, and 89% (93-99) NPV. CONCLUSIONS: Our findings are largely consistent with the current literature, confirming there is discernible potential for inappropriate treatment of patients based purely on EUS-FNA evaluation. Both accuracy and clarity of positive tests with EUS-FNA worsened for mucinous pancreatic lesions compared to solid pancreatic lesions. Limitations of this study are the appraisal at a single institution and the necessity to evaluate only cases that ultimately had surgical resection of the pancreatic lesion. INTRODUCTIONPancreatic ductal adenocarcinoma (PDAC) has the 4th highest cancer mortality rate for both men and women in the United States. The average 5 year survival rate for PDAC patients with localized disease that were able to undergo a resection is approximately 24% [1] . Prognosis is poorer for the 80-85% of patients who are unable to undergo resection due to disseminated disease or ABSTRACT BACKGROUND: The purpose of this study was to assess the clinical impact of diagnostic accuracy for EUS-FNA in evaluating pancreatic lesions, particularly Pancreatic Ductal Adenocarcinoma( PDAC), neuroendocrine tumors, and IPMN at our institution using surgical pathological review as the gold standard. METHODS: We conducted a retrospective chart review using the Clinical Cancer Research Database at Huntsman Cancer Institute. We included all cases in which pancreatic lesions were evaluated by EUS-FNA and a subsequent surgical resection was performed. Sensitivity, specificity, positive predicative value (PPV), and negative predictive value (NPV) were determined for PDAC, neuroendocrine tumors, and IPMN by comparing pathological diagnosis at EUS-FNA to diagnoses following surgery. RESULTS: Detection of PDAC by FNA-EUS yielded 87.9% (80.1-93.4 95% CI) sensitivity, 80% (72-86) specificity, 78% (70-85)

Thymoma is a very rare pediatric tumor, accounting for less than 1% of all childhood mediastinal tumors with scant literature, and only 23 pediatric cases were identified by a pediatric tumor surveillance registry between 1973 and 2008. In contrast to adult thymomas, pediatric thymomas have an aggressive tendency, though the majority is discovered as incidental findings. Patient presentations to the emergency department (ED) are often subtle and non-specific such as dyspnea, cough, and chest pain, requiring a broad differential on the part of the emergency clinician. Because of this presentation, diagnosis often occurs later in the disease process when compared with adults. Chest radiograph may demonstrate an enlarged thymic shadow or cardiomegaly, necessitating further cardiac workup, commonly routed through cardiology. Computed tomography and biopsy are required for definitive diagnosis, requiring a multidisciplinary approach to management. We present a case of a 16-year-old female complaining of progressive dyspnea and chest pain over the course of one to two months with radiographic cardiomegaly. She was found to have a Masaoka stage III World Health Organization (WHO) type B3 thymic endothelial neoplasm and underwent surgical resection.

258 Background: Endoscopic ultrasound-directed fine needle aspiration (EUS-FNA) in combination with imaging is currently the standard preoperative diagnostic method for pancreatic ductal adenocarcinoma (PDA). Previous studies have reported sensitivities and specificities ranging from 80%-90% and accuracies of approximately 85%. Our goal was to determine the accuracy of EUS-FNA for detecting PDA in individual patients at our institution. Methods: We conducted a retrospective chart review using the Clinical Cancer Research Database at Huntsman Cancer Institute (HCI). We included all cases in which pancreatic lesions were evaluated by EUS-FNA and a subsequent surgical resection was performed. All patients that met these criteria at HCI between March 1999 and April 2014 were included. Descriptive variables were calculated by comparing EUS-FNA results to final surgical diagnoses. The variables used to determine these values were; false positive = PDA by EUS-FNA and negative at resection, true positive = PDA for both, false negative = negative for PDA at EUS-FNA and positive at resection, true negative = negative for both. We considered atypical cells positive for PDA since their presence mandates aggressive intervention by the treating clinician. Results: Of the 242 patients that met the inclusion criterion, 139 were female with an average age of 58 +/- 15 (mean +/- standard deviation) and 103 were male with an average age of 62 +/- 13. In terms of diagnosing PDA by EUS-FNA we determined the sensitivity 89% (81%-94%; 95% confidence interval), specificity 76% (68%-83%), positive predictive value of 74% (66%-82%), and negative predictive value 89% (82%-94%). Conclusions: Although our findings are relatively consistent with the current literature, there is discernible potential for inappropriate treatment of patients based purely on EUS-FNA evaluation. Limitations of this study are the appraisal at a single institution and the necessity to evaluate only cases that ultimately had surgical resection of the pancreatic lesion.