Background-Estimation of ventricular volume and mass is important for baseline and serial evaluation of fetuses with normal or abnormal hearts. Direct measurement of chamber wall volumes and mass can be made without geometric assumptions by 3D fetal echocardiography. Our goals were to determine the feasibility of using fast nongated 3D echocardiography for fetal volumetric and mass assessments, to validate the accuracy of the ultrasound system and the measurement technique, and if satisfactory, to develop normal values for fetal ventricular mass during the second and third trimesters. Methods and Results-This was a prospective outpatient study of 90 consecutive normal pregnancies during routine obstetric services at Oregon Health & Science University (Portland). Optimized 3D volumes of the fetal thorax and cardiac chambers were rapidly acquired and later analyzed for right and left ventricular mass by radial summation technique from manual epicardial and endocardial traces. Experiments to validate the ultrasound system and measurement technique were performed with modified small balloon models and in vivo and ex vivo small animal experiments. Our study established the feasibility of fetal ventricular mass measurements with 3D ultrasound technology and developed normal values for right and left ventricular mass from 15 weeks' gestation to term. Conclusions-Nongated fast 3D fetal echocardiography is an acceptable modality for determination of cardiac chamber wall volume and mass with good accuracy and acceptable interobserver variability. The method should be especially valuable as an objective serial measurement in clinical fetal studies with structurally or functionally abnormal hearts.

In highly comorbid patients, the observation of large renal masses has low likelihood for metastatic progression relative to the risk of nonkidney cancer related death. This data supports the use of surveillance as an acceptable strategy for highly selected patients with competing risks from other serious illnesses.

6506 Background: Data on heterogeneity in cancer screening and diagnosis rates among sexual minorities (SMs) is lacking. Recent studies have shown SMs are more likely to engage in risky health behavior and have decreased healthcare utilization compared to heterosexual counterparts. However, few studies have examined how sexual orientation (SO) impacts cancer screening and prevalence. We therefore investigated whether SO affects prevalent gender-specific cancer screening and prevalence, including prostate (PCa), breast (BC), and cervical cancer (CC). Methods: This was a cross-sectional survey-based US study, including men and women aged 18+ from the Health Information National Trends Survey (HINTS) database (part of the National Cancer Institute’s division of cancer control and population sciences) between 2017-2019. The primary endpoint was individual-reported PCa, BC, and CC screening and prevalence rates among heterosexual and SM men and women. Multivariable logistic regression analyses assessed association of various covariates with undergoing screening and diagnosis of these cancers. Results: Overall, 4,441 (95.18%) men and 6,333 (96.75%) women reported a SO of heterosexual whereas 167 (3.6%) and 58 (1.2%) men and 105 (1.6%) and 108 (1.6%) women reported a SO of gay and bisexual, respectively. Mean age was higher in the heterosexual group compared to the gay and bisexual groups in both men (57.7 [±16.0] vs. 52.4 [±14.5] and 51.9 [±18.0] years, p = < 0.001) and women (56.2 [±16.7] vs. 49.0 [±17.1] and 40.0 [±14.8] years, p = < 0.001). Homosexuals and bisexuals were less likely to be screened for PCa (30.53% and 27.58% vs 41.27%, p = < 0.001), BC (63.81% and 45.37% vs 80.74%, p = < 0.001), and CC (90.48% and 86.11% vs 95.36%, p = < 0.001) than their heterosexual counterparts. While rates of PCa and BC diagnoses were similar across SO, more homosexual and bisexual women were diagnosed with CC compared to their heterosexual counterparts (4.76% and 3.70% vs 1.85%, p = 0.039). Multivariable logistic regression models showed that SMs were less likely to be screened for cancer with ORs of 0.61 (95% CI 0.39-0.95, p = 0.030) for PCa, 0.52 (95% CI 0.30-0.92, p = 0.025) for BC, and 0.21 (95% CI 0.09-0.46, p = < 0.001) for CC. Although multivariable models did not show that SMs were more likely to be diagnosed with PC, BC, or CC, SMs were more likely to be diagnosed with any cancer with ORs of 1.64 (95% CI 1.06-2.54, p = 0.026) in women only and 1.50 (95% CI 1.11-2.03, p = 0.009) in men and women combined. Conclusions: These data suggest that in addition to other established and known specific socio-economic risk factors, SMs may be less likely to undergo screening of prevalent malignancies such as PCa, BC, and CC. This provides more evidence of ongoing healthcare inequality, urging our healthcare system to invest more in cancer screening of this vulnerable population.

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Patients with clinically advanced paragangliomas (CA-Para) and pheochromocytomas (CA-Pheo) have limited surgical or systemic treatments. We used comprehensive genomic profiling (CGP) to compare genomic alterations (GA) in CA-Para and CA-Pheo to identify potential therapeutic targets. Eighty-three CA-Para and 45 CA-Pheo underwent hybrid-capture-based CGP using a targeted panel of 324 genes. Tumor mutational burden (TMB) and microsatellite instability (MSI) were determined. The GA/tumor frequencies were low for both tumor types (1.9 GA/tumor for CA-Para, 2.3 GA/tumor for CA-Pheo). The most frequent potentially targetable GA in CA-Para were in FGFR1 (7%, primarily amplifications), NF1, PTEN, NF2, and CDK4 (all 2%) and for CA-Pheo in RET (9%, primarily fusions), NF1 (11%) and FGFR1 (7%). Germline mutations in known cancer predisposition genes were predicted in 13 (30%) of CA-Pheo and 38 (45%) of CA-Para cases, predominantly involving SDHA/B genes. Both CA-Para and CA-Para had low median TMB, low PD-L1 expression levels and none had MSI high status. While similar GA frequency is seen in both CA-Para and CA-Para, germline GA were seen more frequently in CA-Para. Low PD-L1 expression levels and no MSI high status argue against strong potential for novel immune checkpoint inhibitors. However, several important potential therapeutic targets in both CA-Para and CA-Para are identified using CGP.