BMC Cancer 2009, 9:254 http://www.biomedcentral.com/1471-2407/9/254 Table 6: Description of the margin status of the BCS specimen and the re-resection margin status of the nine standardized re- resection margin specimens at the time of the original BCS procedure for all 204 BCS cases, as well as the description of the frequency of patients undergoing a subsequent re-excision breast procedure and the frequency of finding residual disease within those subsequent re-excision breast procedure specimens Description of margin variables for original BCS procedure Status of margin variables for original BCS specimen Frequency of a subsequent re- excision Frequency of residual disease Positive BCS specimen margin(s) 13/204 (6.4%) Close BCS specimen margin(s) 9/204 (4.4%) Positive or close BCS specimen margin(s) 22/204 (10.8%) Negative BCS specimen margins 182/204 (89.2%) Positive re-resection margin(s) 24/204 (11.8%) Positive BCS specimen margin(s) AND 8/204 (3.9%) positive re-resection margin(s) Close BCS specimen margin(s) AND 3/204 (1.5%) positive re-resection margin(s) Positive or close BCS specimen margin(s) 11/204 (5.4) AND positive re-resection margin(s) Positive BCS specimen margin(s) AND 5/204 (2.5%) negative re-resection margins Close BCS specimen margin(s) AND 6/204 (2.9%) negative re-resection margins Positive or close BCS specimen margin(s) 11/204 (5.4%) AND negative re-resection margins Negative BCS specimen margins AND 13/204 (6.4%)@ positive re-resection margin(s) Negative BCS specimen margins AND 169/204 (82.8%) negative re-resection margins Positive BCS specimen margin(s) AND/ 35/204 (17.2%) OR close BCS specimen margin(s) AND/ OR positive re-resection margin(s) 7/13 (53.8%)#,£ 4/9 (44.4%)¶ 11/22 (50.0%)Ω ,£ 0/182 (0%) 15/24 (62.5%)* ,±, Ø, 7/8 (87.5%)£ 3/3 (100%) 10/11 (90.9%)£ 0/5 (0%)# 1/6 (16.7%)¶ 1/11 (9.1%)Ω 5/13 (38.5%)* ,± 0/169 (0%) 16/35 (45.7%)Ω, *, ±, Ø 2/7 (28.6%) 2/4 (50.0%) 4/11 (36.4%) not applicable 4/15 (26.7%) 2/7 (28.6%) 1/3 (33.3%) 3/10 (30.0%) not applicable 1/1 (100%) 1/1 (100%) 0/5 (0%) not applicable 5/16 (31.3%) BCS, breast-conserving surgery #: Five patients with a positive BCS specimen margin declined a subsequent re-excision procedure due to the finding of nine negative standardized re-resection margins. ¶: Five patients with a close BCS specimen margin declined a subsequent re-excision procedure due to the finding of nine negative standardized re- resection margins. £: One patient refused the recommendation of the surgeon for the absolute need of a subsequent re-excision procedure. Ω: Ten patients with a positive or close BCS specimen margin declined a subsequent re-excision procedure due to the finding of nine negative standardized re-resection margins. *: Five patients declined a subsequent re-excision procedure due to the finding of one isolated positive standardized re-resection margin out of nine standardized re-resection margins in which the noncauterized surface (i.e., actual true margin surface) of that standardized re-resection margin was free of tumor and therefore was considered a microscopically negative final margin. ±: Three patients refused the recommendation of the surgeon for the absolute need of a subsequent re-excision procedure. Ø: One patient declined a subsequent re-excision procedure due to the finding of in situ carcinoma within one standardized re-resection margin for which it could not be distinguished as to whether it represented lobular carcinoma in situ versus ductal carcinoma in situ. : Eight of nine patients with multiple positive standardized re-resection margins agreed to a subsequent re-excision procedure. @: 7.1% (13/182) of patients with negative BCS specimen margins had at least one re-resection margin containing additional tumor. finding positive disease in "cavity biopsy" specimens in 8.6% (82/957) of patients with initial negative "wide local excision" margins. In this specific regard, the disconcordance of having neg- ative BCS specimen margins and positive re-resection margins (Table 9), as well as the high degree of discon- cordance shown in cases having both positive/close BCS specimen margins and positive resection margins (Table 10), appears to signify that a substantial percentage of failed BCS procedures may result, not necessarily from unrecognized positive or close margins on the BCS speci- men itself, but rather from the presence of adjacent multi- focal disease within the same quadrant of the affected breast upon which the BCS procedure was performed. Beck et al [30] described this phenomenon as a "discon- tinuous growth pattern commonly seen around primary tumours". Other investigators examining BCS have also described this phenomenon [69,70]. Likewise, Holland et al [71] previously evaluate and discussed this phenome- non in a retrospective review of mastectomy specimens from 1980 to 1982 in which 121 of 282 (43%) mastec- tomy specimens from patients that would have theoreti- cally been candidates for BCS based on standard clinical and radiographic criteria for that time period had addi- tional disease within the affected breast that was greater than 2 cm from the known breast cancer. Despite the plausibility of our above explanation, which is clearly Page 12 of 23 (page number not for citation purposes)