BMC Cancer 2009, 9:254 http://www.biomedcentral.com/1471-2407/9/254 Table 9: Concordance or disconcordance of the spatial location of a positive re-resection margin specimen in comparison to the margin status of the corresponding spatial location on each BCS specimen for each of the 24 cases in which there as at least one positive re-resection margin specimen Description of margin variables and concordance/disconcordance Negative BCS specimen margins AND positive re-resection margins (disconcordant findings) Positive/close BCS specimen margins AND positive re-resection margins (concordant findings) Positive/close BCS specimen margins AND positive re-resection margins (disconcordant findings) Positive/close BCS specimen margins AND positive re-resection margins (both concordant and disconcordant findings) Frequency 13/24 (54.2%) 5/24 (20.8%) 2/24 (8.3%) 4/24 (16.7%) BCS, breast-conserving surgery resectional technique itself to remove the primary tumor mass in its entirety from the affected breast. Thus, by using the nine standardized re-resection margin technique to identify as many such cases that are not realistically amendable to BCS and that instead are truly in need of a completion mastectomy to successfully remove all multi- focality of the breast cancer, it is possible that such an approach could ultimately translate into less local breast recurrences from successful BCS procedures (i.e., better patient selection for those who can be successfully man- aged by BCS and better patient selection for those who should be best managed by completion mastectomy). Multiple authors have previously described various meth- odologies for attempting to recognize residual disease within the walls of the BCS resection bed cavity of the affected breast that is not otherwise well appreciated by the current generally accepted technique of only evaluat- ing of the margins of the BCS specimen alone [21- 23,27,29-32,34,38,43,47,48,53,54,61,66,68,77,78]. Spe- cific to this discussion are those studies that have focus specifically upon methods of further removal of tissue from the walls of the BCS resection bed cavity after the removal of the BCS specimen. Some of those authors have described a "selective cavity margin sampling" technique [21,22,29,31,32,38,47,48,53,54,61,66,68,77,78], while others have described "complete cavity margin re-exci- sion" technique [23,27,30,34,43]. Such a discussion will not include those studies specifically addressing method- ologies for image-guided wire placement, intraoperative ultrasound guidance, radioguided techniques for guiding the resection of the BCS specimen, or intraoperative detec- tion of electrical property changes or optical property changes within the BCS resection bed cavity. As is shown in Table 13, those authors that have described a "selective cavity margin sampling" technique show great variability in their sampling methodology [21,22,29,31,32,38,47,48,53,54,61,66,68,77,78]. These various methods of "selective cavity margin sampling" [21,22,29,31,32,38,47,48,53,54,61,66,68,77,78] were all very effective at demonstrating additional disease within the affected breast that would have been otherwise unrec- ognized by the current generally accepted technique of evaluation of the margin status of the BCS specimen alone. Additionally, a collective conclusion drawn by each of these studies that specifically evaluated the overall BCS margin status based upon both the "selective cavity mar- gin sampling" specimens and the BCS specimen itself was that such a combined approach also effectively reduced the need for a subsequent re-excision procedure to the affected breast at a later time as compared to the reliance only upon the current generally accepted technique of evaluation of the margin status of the BCS specimen alone, specifically for those individuals with involved BCS specimen margins but uninvolved "selective cavity margin sampling" specimens [47,53,61,66,68]. In contrast to the various "selective cavity margin sampling" techniques shown in Table 13 which generally sample up to six areas within the BCS resection bed cavity [21,22,29,31,32,38,47,48,53,54,61,66,68,77,78], our technique of nine standardized re-resection margins attempts to further maximize the number of surfaces of the BCS resection bed cavity that are sampled and evalu- ated, while still limiting the total amount of additional breast tissue removed. Several authors have described a technique of "complete cavity margin re-excision" for comprehensive evaluation Table 10: Concordance or disconcordance of the spatial location of a positive re-resection margin specimen in comparison to the margin status of the corresponding spatial location on each of the 11 cases in which the BCS specimen had at least one positive/close margin and there was also a positive re-resection margin Description of margin variables and concordance/disconcordance Positive/close BCS specimen margins AND positive re-resection margins (concordant findings) Positive/close BCS specimen margins AND positive re-resection margins (disconcordant findings) Positive/close BCS specimen margins AND positive re-resection margins (both concordant and disconcordant findings) Frequency 5/11 (45.5%) 2/11 (18.2%) 4/11 (36.4%) BCS, breast-conserving surgery Page 14 of 23 (page number not for citation purposes)