BMC Cancer 2009, 9:254 http://www.biomedcentral.com/1471-2407/9/254 Table 11: Potential association of patient and tumor variables with a positive final margin status (i.e., as defined as either having a positive margin, a close margin, or a positive re-resection margin) as determined by univariate and multivariate analyses Univariate P-value Multivariate P-value Patient and tumor variables Age Height Weight Body mass index Race Menopausal status Breast sidedness Breast size Neoadjuvant therapy Originally palpable mass Tumor size Tumor location Tumor histopathology (invasive lobular carcinoma) Histologic grade Estrogen receptor positive Progesterone receptor positive Her 2 Neu positive Lymphovascular invasion Associated DCIS Associated axillary lymph node involvement Type of original diagnostic breast biopsy DCIS, ductal carcinoma in situ of the surgical resection margins at the time of BCS [23,27,30,34,43]. Although the "complete cavity margin re-excision" technique seems ideal for achieving the most thorough assessment of the surgical resection margins, it significantly increases the overall volume of tissue removed from the affected breast, it is limited by breast size, and it frequently leads to very suboptimal cosmetic results. MacMillan and colleagues [23,27,24] described a method of "complete cavity margin re-excision" in which the entire cavity wall was excised as a single continuous shell of tissue that was evaluated by permanent histopa- thology, but for which no data was reported on the mar- gin status of the BCS specimen. Beck et al [30] described a method of "complete cavity margin re-excision" in which the entire cavity wall was excised as a single continuous ring of tissue that was evaluated by permanent histopa- thology along with evaluation of the margins of the BCS specimen. Keskek et al [43] described a method of "com- plete cavity margin re-excision" in which the entire cavity wall was excised as four separate specimens (designated superior, lateral, inferior, and medial) that were evaluated by permanent histopathology along with evaluation of the margins of the BCS specimen. These various methods of "complete cavity margin re-excision" [23,27,30,34,43] were all very effective at demonstrating additional disease within the affected breast that would have been otherwise unrecognized by the current generally accepted technique of evaluation of the margin status of the BCS specimen 0.601 0.469 0.977 0.799 0.792 0.777 0.296 0.771 0.655 0.647 0.034 0.411 0.095 0.727 0.541 0.132 0.473 0.374 0.032 0.182 0.430 0.066 0.052 0.015 alone. However, the major drawback to the "complete cavity margin re-excision" technique is that the amount of tissue removed by performing the "complete cavity mar- gin re-excision" can essentially equal the amount of tissue removed as the BCS specimen itself [30], thus doubling the total size the BCS resection bed cavity within the affected breast and thus subsequent negatively impacting on the cosmetic outcome of the BCS procedure. In con- trast to the "complete cavity margin re-excision" tech- niques [23,27,30,34,43], our technique of nine standardized re-resection margins minimizes amount of additional tissue excised from the affected breast for accu- rate assessment of the presence or absence of further dis- ease around the BCS specimen (i.e., representing only 26.8% of the volume of the BCS specimen and 32.6% of the surface area of the BCS specimen) while still maximiz- ing the number of different surfaces within the BCS resec- tion bed cavity that are sampled (i.e., nine standardized re-resection margins). Several investigators have addressed and debated the effi- cacy of the technique of performing gross intraoperative examination of the BCS margins and selective immediate intraoperative re-excision of any given BCS margin that is thought to represent a suspicious or compromised margin [45,46,56,63] as a mechanism to reduce the need for a subsequent second re-excision procedure. We did not uti- lize this methodology in our series of 204 BCS procedures. Page 15 of 23 (page number not for citation purposes)