Core Excision Research Articles

Effectiveness of Core Excision Technique for Keloids: A Systematic Review.

The keloid core excision technique mitigates the risk of wound tension and promotes favorable morphological outcomes. However, whether residual keloid tissue or other factors increase the risk of recurrence remains unclear. This systematic review aimed to evaluate the therapeutic outcomes of core excision techniques for keloids. A systematic literature review was conducted by searching PubMed, Embase, Web of Science Core Collection, and Cochrane Library databases on July 30, 2023. The search terms employed were "keloid," "core excision," "intralesional excision," "intramarginal excision," "rind flap," and "fillet flap." The inclusion criteria for the studies were established in advance and evaluated by multiple investigators. Overall, 20 studies involving 926 keloid cases managed through core excision were included. Adjuvant therapies were used in 19 studies, with radiotherapies and steroid injections emerging as the predominant methods. The recurrence rates ranged from 0% to 28.6%. Residual scar tissue after core excision and complications, such as flap necrosis and hematoma, are the major factors contributing to recurrence. The core excision technique is a surgical treatment of keloids with a low recurrence rate when combined with adjuvant therapies. However, randomized controlled trials and conclusive quantitative studies are necessary to further investigate the effects of the core excision technique on keloids.

Effectiveness of postoperative superficial radiotherapy following the keloid-cross-flap surgery for auricular keloid: A prospective cohort study

Background and purposeRetaining partial keloid skin to make cross flaps (keloid-cross-flap surgery) is a modification of the core excision. This study aimed to compare the effectiveness of superficial radiotherapy versus compression therapy after keloid-cross-flap surgery. Materials and methodsIn this prospective cohort study, auricular keloid patients were consecutively screened from January 2019 to December 2021. They underwent keloid-cross-flap surgery and then enter either the superficial radiotherapy or the compression treatment group. The primary outcome was the one-year keloid recurrence rate. Secondary outcomes included: non-completion rate of adjuvant treatment; Patient and Observer Scar Assessment Scale (POSAS) scores and auricular aesthetics scores, evaluated by a four-point Likert scale (1 = poor to 4 = excellent) of non-recurring patients. Propensity score matching (PSM) was used to eliminate potential confounding factors. Results123 patients were included in the superficial radiotherapy group and 128 in the compression treatment group. Non-completion rate was significantly higher in the compression treatment group (17.97 %), while the loss rate was comparable between the two groups. Overall, 13 patients (13.54 %) relapsed in superficial radiotherapy group, while 22 patients (25.58 %) in compression group (p < 0.05). After PSM, 59 patients in each group were analyzed, and the recurrence rate was lower in the superficial radiotherapy group (13.56 %). Of relapse-free patients, no significant difference was found in PSAS scores, OSAS scores or aesthetic scores between the two groups. ConclusionKeloid-cross-flap surgery could provide favorable morphologic repair of the auricular keloid, and postoperative superficial radiotherapy shows higher compliance and lower recurrence rate comparing to compression treatment.

(030) PATIENT-REPORTED OUTCOMES OF CORE EXCISION FOR SURGICAL MANAGEMENT OF NEUROPROLIFERATIVE VESTIBULODYNIA

Abstract Introduction Among patients with neuroproliferative vestibulodynia (NPV) experiencing pain on cotton-tip swab testing at the 1:00-11:00 vestibule prior to complete vestibulectomy surgery, a subset also had pain at the 12:00 vestibule. Excision of the 12:00 core region may be performed concomitantly or after healing from the vestibulectomy. Given that a vaginal flap cannot be advanced to this area, only a core excision is removed and closed using surrounding 12:00 tissue. Differences between the post-operative improvement in the 1:00-11:00 and the 12:00 regions have not been examined to date. To better understand the success of core excision of the 12:00 region, we assessed post-operative patient-reported outcomes specifically of this vestibular region. Objective To characterize patients who underwent 12:00 excision as well as assess Patient Global Impression of Improvement (PGI-I) specifically regarding 12:00 core excision in individuals with NPV. Methods We performed a retrospective chart review of patients from one clinic who had undergone a 12:00 core excision. Preoperative baseline assessments included Vulvar Pain Functional Questionnaire (V-Q), Female Sexual Function Index (FSFI), Short Form McGill Pain Questionnaire (SF-MPQ), cotton-tip swab test results. Dimensions of the excised tissue as determined by pathology report, responses to the PGI-I scale at &amp;gt; 6 months post-op, and any adverse events were collected. Descriptive statistics were conducted to analyze the PGI-I scores and other outcomes. Results The majority of patients (67%, n=21), with an average age of 26, rated their 12:00 pain as “much improved” or “very much improved” on the PGI-I scale. Mean duration of follow up since surgery was one year and five months, with a minimum follow up of 9 months. Most patients (90%) did not have regrets about having the 12:00 region removed. Most patients (83%) would recommend this surgery to other patients who have 12:00 pain. There were no significant post-operative adverse events with 12:00 excision. Mean dimensions of the excised specimen were 1.01 cm x 0.60 cm x 0.21 cm, 3% of the size of the 1:00-11:00 vestibule excised. Preoperatively, patient reported mean FSFI pain domain was 0.67, SF-MPQ 16.80, affective 5.15 and PPI 3.42. Mean V-Q prior to surgery was 11.68, mean cotton-tip swab test result for the 12:00 region was 6.15. Conclusions Performing core excision of a very small volume of tissue during surgery in patients with 12:00 pain is associated with an improved PGI-I score in 67% of patients. Further research with larger sample sizes and longer follow-up periods is warranted to confirm these findings and optimize the management of vestibulodynia. In patients who fail 12:00 core excision surgery, buccal mucosal grafting of the entire 12:00 vestibule may be a future option. Disclosure No.

Intraductal Papilloma of the Breast: A Case Report

Intraductal papilloma of the breast is a rare benign tumour. The polypoid lesions arising from the nipple surface include papillomas and fibroepithelial stromal polyps. These lesions must be distinguished from malignant nipple lesions, such as Paget’s disease of the nipple or malignant breast conditions involving the nipple. Solitary papillomas (solitary intraductal papillomas) are single tumours that often grow in the large milk ducts near the nipple. They are a common cause of clear or bloody nipple discharge, especially when it comes from only one breast, and can be felt as a small lump behind or next to the nipple. Papillomas may also be found in small ducts in areas of the breast farther from the nipple. Multiple papillomas, which are growths that are less prone to generate nipple discharge, were present in this case. In papillomatosis, there are very small areas of cell growth within the ducts, but they aren’t as distinct as papillomas are. In order to distinguish between these disorders, a thorough clinical examination and imaging are essential. This case report describes a 36-year-old female who presented with swelling from the left nipple. Sonography of the left breast revealed a dilated duct in the left retro-areolar region with a focal isoechoic component within the duct {American College of Radiology Breast Imaging Reporting and Data System (ACR BI-RADS 4B)}. The patient underwent core excision of the duct, and histopathological analysis confirmed the diagnosis of papilloma with changes of adenosis without atypia.

Immediate Cryotherapy After Core Excision: A Promising Approach to Reduce Mechanical Tension in Recalcitrant Keloids.

Immediate Cryotherapy After Core Excision: A Promising Approach to Reduce Mechanical Tension in Recalcitrant Keloids.

Surgical Core Excision With Tongue Flap Closure in Combination With Electron Beam Radiotherapy in the Treatment of Ear Keloids.

Ear keloids are disfiguring disorders resistant to various treatments. The authors aimed to assess the efficacy of surgical treatment of ear keloids in a Chinese population using a tongue flap with electron beam radiotherapy. The authors conducted a retrospective analysis of 41 patients treated at the Affiliated Hospital of Nantong University between January 2018 and May 2021. Core excision with a tongue flap was performed, followed by 3 days of electron beam radiotherapy and 3 to 6 months of pressure clip application. The Vancouver Scar Scale (VSS) and the Visual Analog Scale (VAS) were used to assess the results. The mean age of the patients was 28.10 years (9-61 years). Postoperative follow-up ranged from 5 to 32 months (mean:12.07). The patients underwent 3 days of postoperative radiotherapy followed by pressure clips for 2 to 6 months. Thirty-seven patients had no recurrence, whereas 4 had a mild recurrence (<3 mm in height) with redness and itchiness. The VSS and VASscores significantly decreased. (p < .05). Excision with a tongue flap and radiotherapy can be used as the primary treatment for ear keloids considering the good outcome and long-term management.

Contour first-retrospective study of an algorithmic approach of auricular keloids.

Auricular keloids are difficult to treat, and recurrent keloids are more aggressive and more likely to develop aural deformities. Surgical excision, injections, or radiotherapy alone have high recurrence rates. An algorithmic approach of auricular keloid remains to be explored. To investigate the sequential treatment protocol for the treatment of auricle keloids to maintain auricle morphology and reduce the postoperative recurrence rate. A retrospective analysis of 42 patients who attended the scar minimally invasive treatment center of the Hospital of Plastic Surgery, Chinese Academy of Medical Sciences for serial treatment from January 2019 to June 2021. According to the size and involvement of the keloid, the core excision of the scar was excised under the condition of ensuring the priority of the auricular contour, and the scar flap was repaired to reconstruct the auricular appearance, and electron beam treatment was performed within 24h after the operation, ray energy: 6-7MeV, dose: Dt18Gy/2f; regular trimethoprim combined with 5-Fu injection treatment and the application of silicone ear clips for local compression treatment were performed 1 month after the operation. Thirty-five patients were followed up from 12 to 40 months after surgery, and three of them showed a tendency of recurrence, and early local treatment with trimethoprim and 5-Fu injection achieved favorable results. A standardized and sequential treatment plan for keloids with different morphology and anatomical locations can achieve remodeling of the auricular morphology and maintain long-term results.

Management of Earlobe Keloid by Triple Combination Therapy (Core Excision, Fillet Flap, and Intralesional Corticosteroids): A Case Report

Background: Keloid is a growing neoplasm characterized by the proliferation of benign fibroblasts. The chest, shoulders, head, especially the ear lobes, neck, arms, and upper back are the areas most commonly affected by keloids. The use of a fillet flap allows dissection of the keloid core and leaves loose skin for wound closure. This study aims to describe the surgical management of keloids in the auricular region using the core excision technique with a keloid fillet flap with a combination of corticosteroid injections.&#x0D; Case presentation: A 54-year-old man came with the main complaint of a red lump with hard consistency and itching on the right ear. The management of this patient was surgery using the core excision technique with a keloid fillet flap followed by intra-operative intralesional and immediate post-operative corticosteroid injection and then programmed for corticosteroid injection at the next follow-up. Post-operative therapy was given cefixime 2x100mg and oral analgesic mefenamic acid 3x500mg for 5 days.&#x0D; Conclusion: Keloid surgery is the treatment of choice because it produces good cosmetic results quickly. Routine follow-up and additional therapy are required to prevent a future post-operative recurrence.

Case series of keloid wedge resection in the ear: a focus on aesthetic aspects

Keloid scars may cause a range of symptoms and aesthetic problems. The ear is one of the most frequent sites of keloids, and the earlobe and ear helix account for more than 80% of ear keloids. There are various surgical methods for removing keloids in the ear. Standard keloidectomy and core excision can be effective surgical methods compared to wedge resection since they preserve normal tissue surrounding the keloid. However, ears often show various types of asymmetry by default, which can be relatively difficult to detect, so wedge resection continues to be a useful surgical method for ear keloids. Here, we report four cases of keloids in the earlobe and ear helix that were successfully treated by wedge resection without a postoperative deformity or recurrence.

Perineural 5% Dextrose Injection Treatment and Central Core Excision of the 12:00 Vestibule as Adjunctive Therapies to Complete Vestibulectomy in Select Patients with Neuroproliferative Vestibulodynia

ABSTRACT Introduction Complete vestibulectomy with vaginal advancement flap (CVVAF) for the treatment of neuroproliferative vestibulodynia (NPV) involves excision of the 1:00 to 11:00 region surrounding the urethral meatus and introitus, allowing the vagina and urethral meatus to be anastomosed to the vulva. The vestibule, however, extends above the urethral meatus and below the clitoris (12:00 region). In NPV patients, the entire vestibule including the 12:00 region contains excess mast cells/nerves, however the 12:00 region is not usually addressed during CVVAF surgery. While CVVAF surgery is associated with an approximately 80% success rate, we have observed some patients with significant pain at the 12:00 region pre-operatively who continue to have persistent entrance dyspareunia post-operatively. Objective We report on novel medical/surgical adjunctive strategies for NPV patients with pre-operative 12:00 pain implemented to reduce post-operative pain: using perineural 5% dextrose injection treatments pre-operatively; and performing a limited central core excision of the 12:00 vestibule during CVVAF. Perineural 5% dextrose injections have been shown to reduce neuropathic pain, in part by blocking the transient receptor potential vanilloid - TRPV-1 receptor. Methods In patients scheduled for CVVAF to treat suspected NPV, we performed preoperative vulvoscopy and baseline cotton-tip swab testing at the 12:00 region. In those with significant pain/tenderness at 12:00 (&amp;gt; 4/10 pain), we offered pre-operative perineural 5% dextrose treatments for the three days prior to CVVAF. Each day, cotton-tip swab testing of the 12:00 region was repeated prior to application of local anesthesia with 20% benzocaine, 8% lidocaine, 6% tetracaine. After anesthesia was established, betadine was applied to the region. Insulin syringes (31-gauge needle, 5/16”, 1 ml) filled with 5% dextrose were administered at six locations (total 6 ml) circling the 12:00 region, and compression applied for three minutes. The day after the final treatment, the patient underwent CVVAF including central core excision of the 12:00 region. All vestibular specimens were sent for immunohistochemical staining. Results 14 women, mean age 29 ± 9 years, had 12:00 pain &amp;gt; 4/10 on cotton swab testing at baseline, and confirmed immunohistochemical findings of excess mast cells/nerves consistent with NPV in all specimens. Baseline cotton-tip swab testing mean pain score prior to treatment was 7.3/10 (range 5-10/10) involving the entire 12:00 region. After three perineural 5% dextrose injection treatments, the cotton-tip swab testing mean pain score was reduced to 2.8/10 (range 0-5/10), focused on the central core region of the 12:00 vestibule. Side effects of perineural 5% dextrose injection were limited to mild bruising at injection sites in all patients. The central core excised specimens included the 12:00 minor vestibular gland ostia, and was oval-shaped, on average 2 mm thick, 6 mm wide and 7 mm long. Interrupted vertical sutures of 3-0 vicryl allowed for a horizontal closure of the defect. In patients who returned for in-person post-operative vulvoscopy at 6 months, the post-op cotton-tip swab testing mean pain score was 2.3/10 (range 0-4/10). Conclusions While more research is needed, preliminary results with these adjunctive therapies in selective NPV patients are encouraging. Disclosure No

Comparison of Core Biopsy and Excision Materials in Terms of Histological Type, Histological Grade, Hormone Receptors, and Human Epidermal Growth Factor Receptor 2 Expression in Invasive Breast Carcinomas

Comparison of Core Biopsy and Excision Materials in Terms of Histological Type, Histological Grade, Hormone Receptors, and Human Epidermal Growth Factor Receptor 2 Expression in Invasive Breast Carcinomas

Correlation study of Staphylococcus aureus superantigens and formation of human ear keloid

Objective: To investigate the correlation of Staphylococcus aureus superantigens and human ear keloid formation. Methods: The retrospective case-control study method was used. The discarded keloid tissue was collected from 10 patients (9 females and 1 male, aged 19-59 years) with ear keloid after core excision of ear keloid, and the discarded normal skin tissue was collected from 3 female patients (aged 20-24 years) with pigmented nevus after operation, who were admitted to affiliated Hospital of Nantong University from June 2017 to March 2018. The exudation from ear keloid surface was collected for bacteria culture and identification. The keloid and normal skin tissue were collected to detect the protein expression of Staphylococcus aureus enterotoxin A+enterotoxin B+toxic shock syndrome toxin-1 (TSST-1) by Western blotting, and the keloid was divided into superantigen positive group and superantigen negative group according to the protein expression of Staphylococcus aureus enterotoxin A+enterotoxin B+TSST-1. The protein expressions of T cell receptor (TCR) V β of keloid in 2 groups were detected by Western blotting. Collagen fibers formation and inflammatory cells infiltration in keloid dermis of 2 groups were observed by Masson and hematoxylin eosin staining, respectively. Enzyme-linked immunosorbent assay method was used to detect expression of Staphylococcus aureus enterotoxin A, enterotoxin B, and TSST-1 in keloids with superantigen positive. Data were statistically analyzed with paired sample t test. Results: Bacteria were cultured from the exudation on ear keloid surface, hemolysis was observed around the dominant bacteria after being cultured for 24 hours, and the colony was white or golden yellow, which was identified as Staphylococcus aureus. The protein expression of Staphylococcus aureus enterotoxin A+enterotoxin B+TSST-1 of normal skin was negative in 3 patients, and the protein expression was 0.267±0.016. The protein expression of Staphylococcus aureus enterotoxin A+enterotoxin B+TSST-1 of keloid was positive in 4 patients, with the protein expression of 0.472±0.016, which was included into superantigen positive group, and the protein expression of Staphylococcus aureus enterotoxin A+enterotoxin B+TSST-1 of keloid was negative in 6 patients, with the protein expression of 0.255±0.004, which was included into superantigen negative group. The protein expression of Staphylococcus aureus enterotoxin A+enterotoxin B+TSST-1 of keloid in superantigen positive group was obviously higher than that of keloid in superantigen negative group and that in normal skin (t=15.22, 8.63, P＜0.01). The protein expression of TCR Vβ in keloid of superantigen positive group was 0.389±0.023, which was significantly higher than 0.169±0.014 in superantigen negative group (t=8.62, P＜0.01). Masson staining showed that a large number of collagen fibers existed in dermis of keloid in 2 groups. HE staining showed that there were a small number of inflammatory cells infiltration around the blood vessels of keloid dermis in superantigen negative group and a large number of inflammatory cells infiltration around the blood vessels of keloid in superantigen positive group. Among the 4 patients with superantigen positive keloid, Staphylococcus aureus enterotoxin A was positive in 2 patients, Staphylococcus aureus enterotoxin B was positive in 2 patients, and among that Staphylococcus aureus enterotoxin A and enterotoxin B were both positive in 1 patient, with no TSST-1 detected in any patient. Conclusions: The superantigen secreted by Staphylococcus aureus is one of the many causes of ear keloid, which may be related to the activation of keloid signal pathway by superantigen of Staphylococcus aureus.

Abstract PS18-25: Concordance of immunohistochemical assays between peri-operative and post-operative breast tumor specimens: A prospective observational study of 18 cases

Abstract Background and Rationale: Biomarker evaluation on breast tumor tissue is an important component of clinical research. There is a concern that tissues collected at different times (pre- vs intra-op) and with different techniques (core biopsy vs. surgical excision) produce different results that may confound comparisons of patient samples. Our objective is to address the difference between tumor tissue from the same patient collected pre- vs intra-op and by core biopsy (Core Bx) vs surgical excision, with an emphasis on ER/PgR/HER2/Ki-67 and biomarkers related to insulin metabolism. Design: Following a protocol approved by the IRB, patients with Core Bx proven invasive breast cancer (BC) &amp;gt;1.5 cm in size by imaging underwent a peri-operative Core Bx followed by surgical excision. No neoadjuvant therapy was administered. Formalin-fixed paraffin-embedded tumor sections of the diagnostic and peri-operative Core Bx and surgical excision were immunohistochemically (IHC) stained for ER, PgR, HER2, Ki-67, insulin receptor (IR), phospho-AKT (pAKT), and phospho-AMPK (pAMPK) using standardized protocols on the same platforms. A pathologist (MCC) scored all sections in blinded order to yield H-Scores (which combine percentage of stain-positive cells and staining intensity). The level of agreement for each assay between specimens was assessed by using pairwise models based on normal theory. Results: 18 women (mean age = 66.8 years, 16/18 postmenopausal) provided all specimens. Mean (± SD) invasive tumor size was 2.7 (± 1.2) cm. 1 BC was Nottingham Grade 1 (6%), 9 Grade 2 (50%), and 8 Grade 3 (44%). An in situ component was present in 4/18 (22%) cases (all non-extensive). Lymphovascular invasion was present in 6/18 (33%) cases. 10/18 were node-negative (N0, 56%), 2/18 had isolated tumor cells (pN0[i+], 22%), 5/18 had 1 to 3 nodes (pN1, 28%), 1/18 had &amp;gt;9 nodes involved (pN3, 6%).There was high concordance between diagnostic Core Bx, peri-op Core Bx, and excisions for the standard prognostic markers ER, PgR, and HER2. ER was concordant in all samples including 16/18 (89%) ER-positive and 2/19 (11%) ER-negative BCs. PgR was concordant in 16/18 (89%) of cases. In the 2 discordant cases, PgR was negative in 2 of 3 tissue samples with low expression in the 3rd sample (1 diagnostic Core Bx and 1 excision). HER2 was concordant in all samples in 16/18 (89%) HER2-negative cases and in 2/18 (11%) HER2-positive cases including 1/18 cases (6%) positive by IHC, and 1/18 cases (6%) positive by ISH. Table 1 summarizes the agreement between samples for Ki-67, IR, pAKT, and pAMPK. Ki-67 scores were statistically similar between diagnostic and peri-op Core Bx and excision samples. The IR, pAKT, and pAMPK H-Scores were statistically similar between diagnostic and peri-op Core Bx, but significantly different between Core Bxs versus excisional specimens. There was a systematic tendency towards lower IHC H-Scores in the excisional specimen for IR, pAKT, and pAMPK. Conclusion: Tissue from surgical excisions are susceptible to reduced IHC staining for metabolic markers such as IR, and phosphorylated kinases, when compared to core biopsies. When evaluating non-standard biomarkers for research, core biopsies should be used when possible. Funding: This study was funded by the Hold'Em For Life Charity and the Breast Cancer Research Foundation Table 1: Concordance Between IHC Scores for Ki-67, Insulin Receptor, pAKT, and pAMPKScore: Mean ± Standard DeviationPeri-Operative Core Bx versus Diagnostic Core BxExcision versus Diagnostic Core BxDiagnostic Core BxPeri-Operative Core BxExcisionDifferenceP-valueDifferenceP-valueKi-67 (% Positive)33.5 ± 28.235.9 ± 31.034.2 ± 29.1Mean ± SD: 2.4 ± 5.60.09Mean ± SD: 0.6 ± 6.30.68Range: -7.7 to 12.3Range: -11.5 to 12.2Insulin Receptor (H-Score**)136 ± 102124 ± 9986 ± 78Mean ± SD: -13 ± 530.32Mean ± SD: -51 ± 540.001*Range: -215 to 40Range: -150 to 5Phospho-AKT (H-Score**)102 ± 70100 ± 8641 ± 41Mean ± SD: -1 ± 750.95Mean ± SD: -61 ± 520.0001*Range: -170 to 170Range: -144 to 0Phospho-AMPK (H-Score**)201 ± 79185 ± 78157 ± 86Mean ± SD: -15 ± 760.41Mean ± SD: -44 ± 690.016*Range: -225 to 120Range: -215 to 70* Statistically significant difference in pairwise values based on t-test** H-Score is the percentage of stain-positive cells multiplied by the average intensity score (0 = absent, 1 = faint, 2 = moderate, 3 = strong) Citation Format: Martin C. Chang, Marguerite Ennis, Jaime Escallon, Karina Bukhanov, Ryan JO Dowling, Vuk Stambolic, Pamela J Goodwin. Concordance of immunohistochemical assays between peri-operative and post-operative breast tumor specimens: A prospective observational study of 18 cases [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS18-25.

Receptor Status Accuracy in Breast Cancer: Core Biopsy or Excision? A Mini Review

With the increased prevalence of breast cancer internationally, efficient, cost effective and reliable diagnostic methods...

The Study of Ear Keloids by Surgical Excision with Fillet Flap in a Single Institution

Background and Objectives Keloids are benign dermal fibrous growth and excessive collagen deposition that occur usually after trauma or surgery. In the treatment of keloids, the recurrence rate is relatively high after surgical excision. Fillet flap is known to be a good surgical method for keloid lesions. The purpose of this study is to find out manifestation and compare the results of ear keloids after the surgery by fillet flap.Subjects and Method We retrospectively evaluated 22 patients with ear keloids (n=31) who underwent core excision with fillet flap at the Department of Dermatology, Chosun University Hospital from May 2010 to June 2018.Results With the 22 of treated patients and 31 ear keloid lesions, the average size of keloid lesions was 0.75×1.05 cm2 . The frequencies of occurrence with respect to the location of keloids according to the anatomical structure of the ear were 12 lobule (38.7%), 17 helix (54.8%), 1 antihelical fold (3.2%), and 1 postauricle (3.2%), respectively. There were 14 lobular types (45.2%), 9 dumbbell types (29.0%), 5 button types (16.1%), and 3 wrap-around type (9.7%). Recurrence was found in 8 keloid lesions (25.8%) and 5 patients (22.7%) after the surgery. Earlobe lesions and dumbbell shaped recurred with the highest recurrence rate. Among the 5 patients who relapsed, 4 had family history of keloids.Conclusion The earlobe and dumbbell shaped types showed the highest recurrence rate and family history was also an important risk factor for recurrence. Also, surgical excision with fillet flap can be very effective and is a good way to treat ear keloids.

Key Role of Image Guided Fine Needle Aspiration Cytology in Diagnosing Intra-Abdominal Lesions

Background: Masses in the abdominal cavity are often deep, non-palpable and palpable at times which can be inflammatory, benign or malignant. With increased sophistication of radiologic imaging techniques these deep seated lesions are detected more frequently and confirmed tissue diagnosis is essential for both planning of treatment and staging in case of malignant lesions. Image guided aspiration is an effective way to obtain diagnostic material and avoid diagnostic laparotomy. This study was conducted to categorize various intra-abdominal lesions according to their site of involvement, study their cytomorphological features, and classify them as benign, malignant and inflammatory and assess the utility of image-guided cytology in the diagnosis of intra-abdominal lesions. Methods: This cross sectional study approved was done on image guided fine needle aspiration cytology smears of intra-abdominal masses. Age, sex and site details were retrieved from the archives. Hematoxylin and Eosin stained smears were reviewed by the Cytopathologist and diagnosis was arrived at after correlating with clinical and radiological data. Core biopsy or excision biopsy of the available cases were also reviewed and checked for correlation. Result: A total of 120 cases were studied with age ranging from 18-81years, 30% of patients were in the 61-70 years age group, followed by 27% cases in 51-60 years age group and 20% cases in 41-50 years age group. The male to female ratio was 1.03:1. 62.5% of cases were from hepatobiliary region, followed by 17.5% cases from pancreatic masses and 11 cases (9.16%) from ovarian masses. 80% cases were malignant, 10% were inflammatory cases, 9.2% cases were inconclusive and 1 (0.8) benign lesion. Among the malignant lesions primary malignancies (Hepatocellular carcinomas and Adenocarcinomas) were more common than secondary deposits. This study showed 88.9% sensitivity, 83.3% specificity and 87.5% of diagnostic accuracy. Conclusion: Image guided aspiration of intra-abdominal lesion is a simple, economical, less complicated and less time consuming procedure that differentiates between malignant and non malignant conditions with high accuracy and can be used as pre-operative diagnostic procedure for planning further management of patient.

Surgeon-Performed Vacuum-Assisted Biopsy of the Breast: Results from a Multicentre Australian Study.

Image-guided interventional techniques such as vacuum-assisted biopsy are being increasingly utilised in the diagnosis and management of breast conditions. The purpose of this study was to report the outcome of a series of vacuum-assisted biopsies and vacuum-assisted excisions performed by specialist breast surgeons in a largely outpatient setting. An Australian multicentre trial of ultrasound-guided surgeon-performed vacuum-assisted biopsy (VAB) and vacuum-assisted excision (VAE) of breast lesions was conducted involving three surgeons in three participating centres. VAEs were performed for presumed or proven benign breast lesions only. A total of 225 surgeon-performed ultrasound-guided vacuum-assisted procedures were undertaken in 197 patients. Of the 225 VAB procedures, 51 (22.7%) were performed as diagnostic cores and 174 (77.3%) were undertaken as core excisions. Of the 174 VAE procedures undertaken with intent of completely excising the lesion, successful excision of the lesion was achieved in 165 of these cases (94.8%), with complete excision being judged by the absence of any lesion seen on ultrasound following the procedure or the absence of the lesion on a subsequent interval ultrasound examination. A total of 199 procedures were performed in the outpatients setting under local anaesthesia, and 26 procedures were performed in an operating theatre setting under neurolept anaesthesia. The average size of lesions was 19.3mm in the diagnostic core group and 10.6mm in the core excision group. The average time for either procedure was approximately 14min. Specialist breast surgeons familiar with ultrasound can be readily upskilled to perform vacuum-assisted procedures safely and expeditiously. VAE represents a minimally invasive method of breast lesion management and is a technique with which breast surgeons should become adept.

A multimodal therapeutic approach improves the clinical outcome of auricular keloid patients.

We retrospectively studied the efficacy of personalized therapy with surgical resection plus prophylactic management of postsurgical auricular keloids by intralesional injection of betamethasone and local pressure therapy using magnets in patients with auricular keloids. Surgical excision was performed in all patients, and surgical techniques including fusiform excision of the keloid scar, core excision of the keloid scar followed by flap repair, and scar graft were chosen. A total of 85 patients with 98 auricular keloids were eligible. Seventy-two (74%) patients had primary auricular keloids, and 13 patients had recurrent keloids after surgical excision. Keloids, were located in the helix in 28 (32.9%) cases, in the earlobe in 45 (52.9%) cases, and in the entire auricle in 12 (14.1%) cases. The size of auricular keloids ranged from 10 to 35mm. Surgical resection was uneventful in all cases. Twenty-one (21.4%) patients received fusiform excision, 47 (47.9%) patients underwent core excision and flap repair, and 30 (30.6%) patients received skin grafts. The patients were followed up for median duration of 1year (range: 12-24months). The cure rate was 87.2%, and the recurrence rate was 12.8%. A personalized surgical approach based on the characteristics of auricular keloids in each patient and a multimodal therapeutic regimen including surgical excision, glucocorticoid blockade, and intralesional injection of glucocorticoids and pressure therapy improve the cure rate and reduce the recurrence rate of auricular keloids.

Use of fan-shaped scar flap for reconstruction after auricular keloid core excision: an analysis of 193 lesions in 177 patients

To investigate the clinical effects of fan-shaped scar flaps for reconstruction of the wounds after auricular keloid core excision. 193 auricular keloid lesions in 177 patients were treated. The fan-shaped scar flap, harvested from the surface of the auricle keloid, was clipped into the suitable size. The curved surface of flap was shaped into flat surface to cover the wound after keloid core excision without tension. Adjuvant intralesional injection of corticosteroid was performed intraoperatively and postoperatively. All the flaps survived completely with satisfactory aesthetic results. The effective rate of treatment was 96.4％ (186/193),and the recurrence rate was 3.6％ (7/193). Satisfactory results can be achieved with the fan-shaped scar flap in the reconstruction after auricular keloid core excision. It' s an effective treatment suitable for auricle keloids in different shapes and sizes.

Abstract P5-08-35: Correlation of predictive markers in invasive breast carcinoma in core and excision specimens: A retrospective review

Abstract Background: Testing of biomarkers in biopsies is a critical driver of determining therapy in patients diagnosed with invasive breast cancer. In the past, open surgical biopsy was considered to be the gold standard, but has been supplanted by the less invasive core needle biopsy. It is therefore imperative to know if such biopsies are representative of disease existing within the entirety of the tumor. This is especially the case now that neoadjuvant therapy is offered to patients with early stage tumor prior to surgical excision. In order to confirm that core biopsies are sufficient to serve as the launch point for treatment decision, we have conducted a retrospective review to compare the biomarker results of core biopsies with their corresponding excisional specimens. Previous studies have contained a smaller sample size, thus this is the largest single-site study of its kind. Methods: Data from patients with invasive breast cancer diagnosed between 2006 and 2013 have been retrospectively studied. Results for estrogen receptor (ER), progesterone receptor (PR) and Her2 status were analyzed. When the core biopsy and excisional specimens are either both "positive" or both "negative," the pair is considered to be "concordant." Otherwise, the pair is categorized as "discordant." As per the current ASCO/CAP guideline, hormone receptor status (estrogen and progesterone receptors) is considered positive if there were at least 1% tumor cells positive for either ER or PR. Both IHC and FISH concordance are evaluated for Her2 status. Patients who received neoadjuvant therapy of any kind were excluded from this study. Results: A total of 571 pairs of data totaling 1142 samples were analyzed in this study. Concordance for ER status is 97%, and for PR status is 92%. Concordance for hormone receptor status (when results of ER and PR are combined) between core biopsy and excision is 99%. Concordance for Her2 status, using FISH as the gold standard is 99%. Discussion: Typically, tumors that are ER+ are often also PR+. Nevertheless, they are often treated the same with hormonal therapy whether ER+PR+, ER+PR-, or, less commonly, ER-PR+. Almost all laboratories perform both ER and PR as a standard testing protocol for all breast carcinomas. Therefore, the lower concordance rate for only PR status without taking into consideration ER result is less meaningful. This study shows very high concordance rates for hormone receptor and Her2 status between core needle biopsy and excisional specimens, reiterating that treatment of invasive breast cancers based on the marker results obtained from core needle biopsies is appropriate. Citation Format: Music J, Sahoo S. Correlation of predictive markers in invasive breast carcinoma in core and excision specimens: A retrospective review. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-08-35.