BMC Cancer 2009, 9:254 http://www.biomedcentral.com/1471-2407/9/254 rgpPFmeiohioesgrosrdeyuttcie(oar(ItrBl)geiio,or(CSia3nrnSMpfm)(heD)r,aoeiPsrofsug)reaip-ancmestspyrieosipeodaniccmrita-abslplae(oletdeIeMfxdrca,amflriveno(pitfStmleyeL-rs)ioit,odhfmree-tdelhasdebutiepranreleiaan(rlMsieo(tI-)srLc,t)o(la,aSnta)dse,nearsdaruvdldpi(inezLger)ip,dosi-unr-refe--- Photograph of a typical example of the nine stand- ardized re-resection margins sampled from the supe- rior (S), superior-medial (SM), superior-lateral (SL), medial (M), lateral (L), inferior (I), inferior-medial (IM), inferior-lateral (IL), and deep-posterior (DP) aspects of a left-sided breast-conserving surgery (BCS) resection bed cavity. The concordance and disconcordance of the spatial loca- tion of a positive re-resection margin specimen in com- parison to the margin status of the corresponding BCS specimen was assessed for all cases in which there was at least one positive re-resection margin among the nine submitted standardized re-resection margin specimens. When both a BCS specimen margin was defined as a "pos- itive" margin or as a "close" margin and one or more of the standardized re-resection margin specimens was defined as "positive", the spatial location of these findings were evaluated to assess concordance versus disconcord- ance of these findings. A concordant finding was defined as having an exact-matched finding within the same- named location or a near-matched finding within the same-named location for a BCS case having both a "posi- tive" margin or a "close" margin on the BCS specimen at a specifically defined margin location (i.e., superior, medial, lateral, inferior, or deep-posterior) and a "posi- tive" standardized re-resection margin specimen of the corresponding standardized re-resection specimen loca- tion (i.e., superior, superior-medial, superior-lateral, medial, lateral, inferior, inferior-medial, inferior-lateral, or deep-posterior). In this instance, an exact-matched finding was defined as being within the same-named loca- tion for the BCS specimen margin location (as pertaining only to the superior, medial, lateral, inferior, and deep- posterior aspects) and for the standardized re-resection margin specimen location (as pertaining only to the supe- rior, medial, lateral, inferior, and deep-posterior aspects). In this instance, a near-matched finding was defined as being within one adjacent location for the BCS specimen margin location (as pertaining only to the superior, medial, lateral, and inferior aspects) and for the standard- ized re-resection margin specimen location (as pertaining only to the superior, superior-medial, superior-lateral, medial, lateral, inferior, inferior-medial, and inferior-lat- eral aspects). A disconcordant finding was defined as hav- ing a non-matched finding of a "positive" margin or a "close" margin on the BCS specimen at a specifically defined margin location as compared to the "positive" standardized re-resection margin location. In this instance, a non-matched finding was defined as being at a spatial distance of more than one adjacent location away from one another for the BCS specimen margin locations (as pertaining only to the superior, medial, lateral, and inferior aspects) and for the standardized re-resection margin specimen locations (pertaining only to the supe- rior, superior-medial, superior-lateral, medial, lateral, inferior, inferior-medial, and inferior-lateral aspects). Additionally, we utilized the term disconcordant finding to define a BCS case in which there were "negative" BCS margins while having one or more "positive" standard- ized re-resection margin locations. Lastly, in those instances in which there were multiple "positive" findings for a given BCS case, the classification could be expanded to include concordant findings, disconcordant findings, or both simultaneously concordant and disconcordant findings. The histopathologic findings from the official, finalized pathology report for each BCS case was discussed in per- son with each patient at the one-week postoperative fol- low-up visit. The potential clinical significance and implications of any abnormal findings seen on his- topathologic evaluation (i.e., concern of a compromised surgical margin of resection as defined by a positive BCS specimen margin, a close BCS specimen margin, and/or a positive re-resection margin) were explained to each patient. All scenarios, in which further surgical interven- tion to the affected breast was thought to be of potential benefit, were fully disclosed to and discussed with each patient and those scenarios were appropriately managed in those patients who accepted such further surgical inter- vention to the affected breast. Patients were referred to radiation oncology for consider- ation of standard postoperative whole-breast radiation therapy to the affected breast as part of their breast-con- serving therapy. Additionally, patients were referred to Page 5 of 23 (page number not for citation purposes)