Oral (pre-recorded)
General HPB 		  
OG02 General HPB: Imaging 
Selection of Presentations from Abstract Submissions
OG02-01 Development and Improvement of Real-Time Navigation System for Laparoscopic Hepatectomy
Tsuyoshi Igami, Japan

T. Igami, T. Ebata, Y. Yokoyama, T. Mizuno, J. Yamaguchi, S. Onoe, N. Watanabe, M. Nagino
Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Japan

Introduction: We are going to try development of real-time navigation system for laparoscopic hepatectomy, which resembles a car navigation system. We report our real-time navigation system and surgical procedure.
Methods: Virtual images are reconstructed using “New-VES” system developed by Nagoya University Graduate School of Information Science. These images correspond to maps of car navigation system. Some of patient's body parts are registered in virtual images using a magnetic position sensor. Patient's body after registration corresponds to The Earth. A transmitter for magnetic position sensor, which corresponds to an artificial satellite, is placed about 30cm above patient's body. A micro magnetic sensor, which corresponds to GPS antenna, fixes on the handling part of laparoscope.Fiducial registration error (FRE) is utilized to evaluate accuracy of real-time navigation system.
Results: We performed laparoscopic hepatectomy using this system in 21 patients. Mean FRE of initial 5 patients was 17.7mm. First improvement was that MDCT were taken using radiological markers for registration of body parts. Mean FRE of the 8 patients who utilized first improvement was 10.2mm and decreased (p = 0.014). Second improvement was that a micro magnetic sensor as an intraoperative body position sensor was fixed on the right-sided chest wall and meant that pre- and post- operative FRE was similar due to an intraoperatively automatic correction of gap of body position. Preoperative and postoperative mean FRE of the 8 patients who utilized second improvement were 11.1mm and 10.1mm (p = 0.250).
Conclusions: Our real-time navigation system can assist laparoscopic hepatectomy.
OG02-03 18Fluorodeoxygluocose Uptake Portends Poorer Prognosis in Grade 2 Gastroenteropancreatic Neuroendocrine Neoplasms: Time to Rethink Imaging Strategies?
Prasad Pande, India

P. Pande, G. Desai, R. Shah, P. Jagannath
Lilavati Hospital and Research Centre, India

Introduction: Grade-2 neuroendocrine neoplasms (G2 NENs) (Ki-67 index 3-20%) are diverse entities with diagnostic and therapeutic challenges. 18fluorodeoxyglucose (18FDG) uptake in these lesions is a marker of proliferation irrespective of the Ki-67 index. This study analyses survival patterns in G2 NENs with 18FDG positive lesions.
Methods: Retrospective analysis of prospectively entered data of NENs revealed 64 cases of G2 NENs at our specialized hepatopancreatobiliary centre. These were divided into 2 groups, those with 18FDG-avid lesions (group A) and those without (group B).
Results: 37 (57.8%) out of 64 patients were in group A. 21 (32.8%) of these presented with metastatic disease, and liver was the most common metastatic site (16 patients, 25%) followed by lymph nodes (12 patients, 18.75%). 10 (15.6%) out of 27 patients in group B had metastatic disease, and lymph nodes (8 patients, 12.5%) were the commonest site followed by liver (4 patients, 6.25%). 17 (26.5%) patients in group A underwent curative or debulking surgery, compared to 21 (32.8%) of group B. Median recurrence-free and overall survival in group A was 14.7 months and 31.4 months, and that in group B was 29.2 months and 108.1 months, respectively. Mortality was 9 patients (14.06%) in group A, and 3 (4.6%) in group B.
Conclusion: 18FDG-avid G2 NENs more commonly present with metastatic disease, are less frequent surgical candidates with poorer survival. Adding 18FDG-PET scan to the diagnostic algorithm of G2 NENs in addition to Somatostatin receptor-based imaging may improve outcomes by selecting patients for aggressive Cisplatin-based chemotherapy.
ParameterGroup A (18-FDG positive)Group B (18-FDG negative)
Number of patients37 (57.8%)27 (42.1%)
DOTA positive (dual positive)16 (25%)27 (42.1%)
Liver metastases at presentation16 (25%)4 (6.25%)
Curative/debulking resection17 (26.5%)21 (32.8%)
Everolimus {First line for G2}24 (37.5%)10 (15.6%)
Eto-Cis {First line for high grade G2/G3}8 (12.5%)0
Cap-Tem {Second line G2/G3}12 (18.75%)8 (12.5%)
Recurrence free/ Overall survival14.7/31.4 months29.2/108.1 months
Mortality9 (14.06%)3 (4.6%)
[Comparison of the two groups of Grade 2 NENs]
OG02-04 Systematic Scoping Review of the Relationship between Molecular Profile and Radiomics of Colorectal Liver Metastases (CRLM)
Atandrila Das, Australia

A. Das
Peter MacCallum Cancer Centre, `Melbourne, Australia

Introduction: Radiomics is an emerging field in medical research, with the main purpose to aid decision-making and outcome prediction for clinicians. We present a systematic scoping review of the relationship between molecular profile and radiomics of CRLM.
Methods: The search was performed in PubMed and Embase. Screening of identified articles was undertaken according to PRISMA flow chart. Inclusion criteria were colorectal liver metastases, imaging feature, molecular profile, radiomics/radiogenomics.
Results: The search identified 966 articles of which 960 were excluded. Additional two articles were included from chain search (table 1).
The findings of this review suggests a correlation between CRLM molecular profile and radiomics. Most of the studies identified were looking at FDG PET (four articles), followed by CT (three articles) and MRI (one article). The most frequently investigated molecular profile was RAS mutation. Statistically significant correlations between molecular profile and imaging features were found for all three mentioned imaging modalities.
Regarding FDG PET, statistically significant correlations were found between SUV and KRAS, GLUT1, Ki67, p53, PKM2 and HIF1-α.
Regarding CT, statistically significant correlations were found between MICA A 5.1 and a better tumour morphology as well as between RAS and optimal morphologic response.
Regarding MRI, statistically significant correlations were found between ADC and BCL-2, Ki67 and VEGF-A.
Conclusion: This systematic review presents eight studies that show correlations between CRLMs imaging features and molecular profile, suggesting that CRLM molecular profile seem to influence radiomic findings, which has the potential to facilitate decision making and care of patients by clinicians.