BMC Cancer 2009, 9:254 http://www.biomedcentral.com/1471-2407/9/254 breast cancer. This translated into 42.2% (62/147) of patients had positive margins on BCS specimens when there was specifically no confirmed preoperative diagno- sis of invasive breast cancer. This difference was highly sig- nificant on both univariate and multivariate analyses (P < 0.001). Similarly, Smitt et al [58] showed that 71.3% (234/328) of those without a preoperative diagnosis of invasive breast cancer had positive/close margins (defined by tumor within 2 mm from the inked edge) on the BCS specimen in comparison to only 47.8% (32/67) of those with a preoperative diagnosis of invasive breast cancer on core/FNA had positive/close margins on the BCS speci- men (P < 0.0001). Finally, in our current series, the finding of DCIS in con- junction with invasive carcinoma was the only variable that we evaluated that was associated with a "positive final margin status" on both univariate and multivariate analy- ses (Table 11). This association of having a "positive final margin status" when DCIS is found in conjunction with invasive carcinoma has been previously described in the literature [41,44,84]. Such an association is thought to be an important predictor of finding residual disease within the affected breast at the time of re-excision [25,85-87], as well as an important predictor of long-term recurrence of disease within the affected breast [88-96]. However, a more in-depth characterization of this association can not be gleaned from our current results since we did not attempt to distinguish the simple finding of associated DCIS from that of the more intricate definition of finding of an extensive intraductal component associated with an invasive breast cancer. Conclusion In our current report, we have presented a standardized and reproducible methodology for comprehensive and systematic assessment of surgical resection margins dur- ing BCS. Such a combined approach gives rise to the con- cept of determination of region clearance of tumor burden within the affected breast by taking into account both the potential for microscopically recognized or unrecognized compromise of the surgical resection mar- gins of the BCS specimen itself, as well as the potential for unrecognized multifocality of disease within the same quadrant of the affected breast. Our methodology accu- rately assesses the adequacy of surgical resection margins for determination of which individuals may need further resection to the affected breast in order to minimize the potential risk of local recurrence following BCS, while attempting to limit the volume of additional breast tissue excised at the time of BCS. Likewise, our methodology is useful in determining which individuals are not realisti- cally amendable to BCS and that are instead in need of a completion mastectomy to successfully remove multifo- cal disease that would have otherwise been unrecognized by traditional resectional techniques for BCS that do not routinely utilize some sort of re-resection margin tech- nique. Competing interests The authors declare that they have no competing interests. Authors' contributions SPP was the surgeon who performed all the BCS proce- dures. He designed the current study, collected the data, and performed all data analyses. He organized, wrote, and edited all aspects of this manuscript. REJ was the patholo- gist who was involved in reading the original histopathol- ogy for many of the cases contained within this series, was responsible for reevaluating those cases with "close" mar- gins, and was involved in the writing and editing of the manuscript. WPW was the pathologist who was involved in reading the original histopathology for some of the cases contained within this series and was involved in the writing and editing of the manuscript. RXX was involved in the technical aspects of the data analyses and was involved in the writing and editing of the manuscript. All of the authors have read and approved the final version of this manuscript. Acknowledgements The authors are grateful to Dr. Donn C. Young (Center for Biostatistics of the Arthur G. James Cancer Hospital and Richard J. Solove Research Insti- tute and Comprehensive Cancer Center of The Ohio State University) for his assistance in the data analyses presented in this manuscript. The authors are grateful to Dr. Vish Subramaniam (Department of Mechanical Engineer- ing and Chemical Physics Program, The Ohio State University) for his tech- nical assistance with some of the computational aspects of the data presented in this manuscript. The authors are grateful to Dr. Fawn Langer- man for her assistance in the initial aspects of data collection. References 1. Burak WE, Agnese DM, Povoski SP: Advances in the surgical management of early stage invasive breast cancer. Curr Probl Surg 2004, 41:877-936. 2. National Comprehensive Cancer Network (NCCN) Clinical Guidelines in Oncology for Breast Cancer (V.1.2009) [http:/ /www.nccn.org/professionals/physician_gls/PDF/breast.pdf] 3. 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