BMC Cancer 2009, 9:254 http://www.biomedcentral.com/1471-2407/9/254 Table 13: Studies reporting "selective cavity margin sampling" techniques for breast-conserving surgery (BCS) Citation Methodology for "selective cavity margin sampling" Umpleby 1988 [21] 5 "cavity biopsies" from the superior, inferior, lateral, medial, and deep margins of the cavity wall that were evaluated by permanent histopathology, but for which no data was reported on the margin status of the BCS specimen England 1994 [22] 5 "tumour bed biopsies" from the superior, inferior, medial, lateral, and base of cavity that were evaluated by permanent histopathology along with evaluation of the margins of the BCS specimen Weber 1997 [29] 5 "tumor cavity biopsies" from the medial, lateral, superior, inferior, and deep aspects of the lumpectomy cavity that were evaluated by frozen section and permanent histopathology, but for which no data was reported on the margin status of the BCS specimen Dibiase 1998 [31] 5 "tumor cavity shaved biopsies" from the medial, lateral, superior, inferior, and base of cavity that were evaluated by permanent histopathology, but for which no data was reported on the margin status of the BCS specimen Taylor 1998 [32] 4 "bed biopsies" from each of the 4 quadrants of the post-resection bed that were evaluated by permanent histopathology, but for which no data was reported on the margin status of the BCS specimen Jenkinson 2001 [38] 4 "tumour bed biopsies" from each of the 4 quadrants of the post-resection bed that were evaluated by permanent histopathology along with evaluation of the margins of the BCS specimen Cao 2005 [47] 4 to 6 "cavity margins" from either the superior, inferior, medial, lateral, anterior, and/or posterior aspects of the residual cavity that were evaluated by permanent histopathology along with evaluation of the margins of the BCS specimen Cendán 2005 [48] 5 to 6 "cavity margins" from either the lateral, medial, inferior, superior, deep, and/or superficial aspects of the lumpectomy cavity that were evaluated by frozen section and permanent histopathology, but for which no data was reported on the margin status of the BCS specimen Huston 2006 [53] Comparative study of taking 4 to 6 "additional margins" versus 1 to 3 "additional margins" versus no "additional margins" (with the specific excision locations not designated for those "additional margins") that were evaluated by permanent histopathology along with evaluation of the margins of the BCS specimen Janes 2006 [54] 2 standardized "cavity shaves" from the superior and inferior aspects of the residual cavity that were evaluated by permanent histopathology along with evaluation of the margins of the BCS specimen Olson 2007 [77] 3 to 6 "cavity margin biopsies" from the walls of the BCS cavity that were evaluated by frozen section and permanent histopathology, but for which no data was reported on the margin status of the BCS specimen Jacobson 2008 [61] 4 to 6 "shaved margins" from either the superior, inferior, medial, lateral, anterior, and/or posterior aspect of the lumpectomy cavity that were evaluated by permanent histopathology along with evaluation of the margins of the BCS specimen Marudanayagam 2008 [78] Up to 4 "cavity shavings" from either the superior, inferior, medial, and/or lateral aspects of the cavity that were evaluated by permanent histopathology, but for which no data was reported on the margin status of the BCS specimen Tengher-Barna 2009 [66] 4 "cavity margins" from the lateral, medial, superior, and inferior of the lumpectomy cavity that were evaluated by permanent histopathology along with evaluation of the margins of the BCS specimen Hewes 2009[68] 4 "cavity biopsies" from the 4 quadrants of the residual cavity that were evaluated by permanent histopathology along with evaluation of the margins of the BCS specimen BCS, breast-conserving surgery nique is that the total area of the general periphery of the BCS specimen itself that is microscopically examined is significantly greater. Therefore, the use of one or the other of these two sampling techniques, when applied to the BCS specimen itself, represent a compromise between allowing direct microscopic visualization of the relation- ship between the tumor and the surgical resection mar- gins and providing variable degrees of the total breast tissue "surface" area that is microscopically examined for surgical margin assessment. It is evident that the use of the "tangential shaved mar- gins" technique on the BCS specimen itself [59] results in a significantly higher rate of "margin positivity" than what is generally seen by the more widely accepted technique of "perpendicular margins" for assessment of surgical resec- tion margins on the BCS specimen itself. Since, within our current study methodology, we did not compare the effi- cacy of the "tangential shaved margins" technique versus that of the "perpendicular margins" technique for assess- ment of surgical resection margins on the BCS specimen itself, it is difficult for us to critically debate the pros and cons of the use of the "tangential shaved margins" tech- nique for assessment of surgical resection margins on the BCS specimen itself. Nevertheless, we, as well as others [59,81,82], do recognize that, in general, the concept of a "tangential shaved margins" technique is an obvious and important step toward improving the currently accepted and utilized methodology for the assessment of surgical resection margins on the BCS specimen alone. This is sim- ply because the "tangential shaved margins" technique on the BCS specimen itself dramatically increases the total breast tissue "surface" area of the BCS specimen that is available for surgical resection margin assessment, while, on the other hand, the "perpendicular margins" technique on the BCS specimen itself can be intrinsically less sensi- tive secondary to the fact that it provides surgical resection margin assessment of only a much smaller fraction of the surface area of the BCS specimen itself. Yet, at the same time, we also believe that the use of the "tangential shaved Page 18 of 23 (page number not for citation purposes)