BMC Cancer 2009, 9:254 http://www.biomedcentral.com/1471-2407/9/254 Table 3: Summary of BCS specimen variables from the pathology report of the 204 BCS cases BCS specimen variables Dimension 1: Length (cm) Dimension 2: Width (cm) Dimension 3: Height (cm) Volume of BCS specimen (cm3) Surface area of BCS specimen (cm2) Surface area of overlying skin ellipse (cm2) Surface area of BCS specimen minus overlying skin ellipse (cm2) Weight (gm) BCS, breast-conserving surgery #: The BCS specimen weight was available for only 162 of the 204 BCS cases. prehensive and systematic assessment of surgical resection margins during BCS for invasive breast cancer while still limiting the volume of additional breast tissue excised remains an important issue to clinicians for most opti- mally assessing which individuals need further resection of the affected breast and for minimizing the long-term risks of local recurrence following BCS. In our current series, 6.4% (13/204) of patients had posi- tive BCS specimen margins (defined as tumor cells at the inked edge of the BCS specimen) and 4.4% (9/204) of patients had close margins (defined as tumor cells within 1 mm or less of the inked edge but not at the inked edge of the BCS specimen). Based on a 1 mm or less criteria for the concern of a compromised surgical margin of resec- tion at the time of a BCS procedure, a total of 10.8% (22/ 204) of patients were counseled about the potential clini- cal significance and implications of these findings. Our results, as compared to the multitude of other reported series showed in Table 12[20-68], are very respectable and are reflective of both the adherence to appropriate patient selection for BCS that was used by the surgeon performing these BCS procedures as well as the standardized rationale and technique that was used by the surgeon for the deter- mination of the extent of tissue resection during each BCS procedure. Additionally, 11.8% (n = 24) of all 204 patients had at least one re-resection margin containing additional invasive carcinoma or DCIS, independent of the status of the BCS specimen margins. This included 7.1% (n = 13) of the 182 patients with negative BCS spec- imen margins (defined as no tumor cells seen within 1 mm or less of the inked edge of the BCS specimen) who had at least one re-resection margin containing additional invasive carcinoma or DCIS. Therefore, of the total of 24 patients with at least one re-resection margin containing additional invasive carcinoma or DCIS, 13 (54.2%, P < 0.001) represented individuals that had additional adja- cent invasive carcinoma or DCIS that was not recognized by a standard BCS procedure alone, based upon the find- ings of negative BCS specimen margins (Table 9). Of a Mean measurement (range) 8.5 (4.4 – 18.7) 6.8 (2.5 – 12.8) 3.1 (2.0 – 7.0) 103.3 (12.0 – 538.9) 122.5 (28.9 – 437.9) 8.0 (0 – 47.1) 113.7 (21.2 – 421.7) 86.9 (15 – 330)# similarly related note regarding disconcordance, even when one or more of the BCS specimen margins were pos- itive/close, 6 of 11 (54.5%) of such patients that also had at least one positive re-resection margin had some degree of disconcordance between the positive/close BCS speci- men margin status and the positive re-resection margin status (Table 10), thus further recognizing the failure of surgical resection margin assessment that is solely based upon only evaluating the BCS specimen margins them- selves. The pattern of having disconcordant findings, in which there are negative margins on the BCS specimen itself despite the finding of further disease within additionally re-excised tissue from within the BCS resection bed cavity, has been previously reported by multiple other authors [22,30,38,43,47,53,66,68]. In 1994, England et al [22] reported finding positive disease in the "tumour bed biopsy" re-excision specimens in 9.6% (5/52) of patients with initial negative "wide local excision" margins. In 1998, Beck et al [30] reported finding positive disease in the "entire cavity wall" re-excision specimen in 13.3% (14/105) of patients with initial negative "wide local exci- sion" margins. In 2001, Jenkinson et al [38] reported find- ing positive disease in the "cavity bed biopsy" re-excision specimens in 6.0% (5/83) of patients with initial negative "segmental mastectomy" margins. In 2004, Keskek et al [43] reported finding positive disease in "complete cavity margin excision" specimens in 4.3% (13/303) of patients with initial negative margins on the "initial tumour exci- sion". In 2005, Cao et al [47] reported finding positive disease in the "cavity margin" re-excision specimens in 8.7% (2/23) of patients with initial negative "lumpec- tomy" margins. In 2006, Huston et al [53] reported find- ing positive disease in "additional margin" specimens in 6.4% (3/26) of patients with initial negative "lumpec- tomy" margins. In 2009, Tengher-Barna et al [66] reported finding positive disease in "cavity margin" specimens in 10.3% (11/107) of patients with initial negative "lumpec- tomy" margins. Finally, in 2009, Hewes et al [68] reported Page 10 of 23 (page number not for citation purposes)