Financial Disclosure: The authors did not report any potential conflicts of interest. ONCOLOGY Risk of Cancer and Performance of Ultrasound in Postmenopausal Women Who Failed Endometrial Biopsy [36R] Georgios Doulaveris, MD Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY Alice Chen, MD, Theofano Orfanelli, MD, Pamela Escobar, MD, Pe’er Dar, MD, PhD, and Ohad Rotenberg, MD INTRODUCTION: To assess the risk of endometrial cancer or hyperplasia (EmCH) and the performance of transvaginal ultrasound (TVS) in postmenopausal women who had a failed endometrial biopsy (EMB). METHODS: Retrospective study of all women, aged 55 and older, who underwent EMB between 1997 and 2008. Failed EMB was defined as “absent” or “insufficient” endometrial tissue. Patients’ data was collected until 2015 for long term surveillance. We assessed TVS utilization, the ability of TVS to provide adequate measure- ment of the endometrial echo (EE) and performance of TVS for detection of EmCH. For the performance of TVS we used EE cutoff of $5 mm. RESULTS: 1808 postmenopausal women underwent EMB during the study period. In 269 (14.9%), endometrial sampling failed to obtain tissue. Of these cases, 16/269 (5.9%) had a final diagnosis of EmCH. 125/269 (46.5%) of women had concurrent TVS to assess their endometrium. EE could be adequately visualized in 111/125 (88.8%). Mean EE was significantly thicker in women eventually diagnosed with EmCH compared to those with benign diagnosis (17.4 mm vs 10.2 mm, p5 0.01). In women who had insufficient EMB and had accessible EE measurements via TVS, endometrial thickening had a sensitivity of 100%, specificity of 46.1%, NPV of 100% and PPV of 11.1% in diagnosis of EmCH. CONCLUSION: EMB failed to obtain tissue in 14.9% of postmen- opausal women of which 5.9% had EmCH. TVS provided adequate EE measurement in 88.8% of these cases. Thick endometrium had 100% sensitivity and 100% NPV in the diagnosis of EmCH but with low specificity and PPV. Financial Disclosure: The authors did not report any potential conflicts of interest. Trends in Utilization of Brachytherapy in Cervical Cancer in a Single Military Medical Center [37R] Calen W. Kucera, MD, MPH Brooke Army Medical Center/United States Air Force, San Antonio, TX Caela Miller, MD INTRODUCTION: Standard of care (SOC) treatment for locally advanced cervical cancer consists of chemotherapy, external beam radiation and brachytherapy. Despite significant survival benefits, there is a national decline in utilization of brachytherapy in recent years. Currently only 44% of US patients with locally advanced cervical cancer receive brachytherapy. We believe military medicine and our military medical center has avoided this trend and correctly administers SOC treatment for locally advanced non-operable cervical cancer. METHODS: We utilized the Brooke Army Medical Center Tumor Registry to identify women with locally advanced cervical cancer between January 1997 and March 2018. We reviewed medical records to determine if they received SOC treatment as well as potential associated demographic factors. Data was then analyzed using logistic regression models. (IRB approval was obtained). RESULTS: We found that of the 147 patients with cervical cancer, 36 had locally advanced cervical cancer, 28 (77.8%) met SOC treatment. We found no statistically significant associated factors to include race, rank, duty status, or stage. Reasons for not completing SOC treatment included vesico-vaginal and recto-vaginal fistulas, declining treatment, and rare histologies. CONCLUSION: Our military institution has nearly double the rate of SOC brachytherapy compared to national use. Although we have a small sample size we expect that these trends would be consistent across military medical centers. The contribution of economic and social factors that decrease use of brachytherapy nationwide may be mitigated by the equal access to care provided by military medicine, and the decrease in out of pocket expenses by military beneficiaries at military facilities. Financial Disclosure: The authors did not report any potential conflicts of interest. Using Quality Improvement to Increase the Awareness of Obesity Among Endometrial Cancer Patients [38R] Anousheh Shafa, MD Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN Diogo Torres, MD, Megan Bird, PA, Manpreet Mundi, MD, Carrie Langstraat, MD, and Amanika Kumar, MD INTRODUCTION: Obesity is associated with endometrial cancer (EC); however, most patients are unaware of this association and the long-term consequences of their elevated body mass index (BMI). Our objectives were to increase both patient awareness of this association and referral rates to our weight loss clinic using quality improvement (QI) methodology. METHODS: A multidisciplinary team used QI methods to create a multi-pronged toolkit to improve obesity education in patients , 80 years old with a BMI $30 mg/kg2 and diagnosis of grade 1-2, stage I EC. Gynecologic oncology and bariatric surgery providers, endocri- nologists, nutritionists, and psychologists collaboratively implemented the toolkit comprised of provider communication workshops, patient education resources, and dictation templates. A historic cohort from (July through December 2015) was compared to a post-intervention cohort (July through December 2017). Clinical characteristics, docu- mented conversations, and referrals to the weight loss clinic were abstracted. Data for the two cohorts were compared using Chi- squared test, Fisher exact test, and Student t-test. RESULTS: The historic cohort had 54 patients and the post- intervention cohort had 53 patients. Clinical characteristics were balanced between groups. Conversations about obesity increased from 11.1% (6/54) to 79.2% (42/53) after toolkit implementation (P,.001). Referral rates to the weight loss clinic also increased from 3.7% (2/54) to 25.9% (14/53) (P,.005). No clinical characteristics, including age, BMI, or pre-operative diagnosis, were associated with documented conversations or referrals (P51.0). CONCLUSION: A multidisciplinary quality improvement project can be used to increase discussion about obesity and referral to a weight loss clinic in patients with low-risk EC. Financial Disclosure: The authors did not report any potential conflicts of interest. Impact of Histology on Racial Disparities in Epithelial Ovarian Cancer Patients [39R] Eric R. Craig, MD Walter Reed National Military Medical Center, Bethesda, MD Christopher Tarney, MD, Chunqiao Tian, PhD, Yovanni Casablanca, MD, and Kathleen Darcy, PhD INTRODUCTION: Epithelial ovarian cancer (EOC) is the most lethal gynecologic malignancy. Racial disparities between non- Hispanic white (NHW) and non-Hispanic black (NHB) patients with EOC has been documented, but data on the existence of disparities among other races is lacking. The objective of this study was to investigate the relationship between race, histology, and survival in EOC. METHODS: Data from women diagnosed with invasive EOC including serous, endometrioid, clear cell, and mucinous histology VOL. 133, NO. 5 (SUPPLEMENT), MAY 2019 SUNDAY POSTERS 201S © 2019 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.