BCS specimen margin Superior (S) margin Medial (M) margin Lateral (L) margin Inferior (I) margin Deep-Posterior (DP) margin Anterior-Skin (AS) margin BCS specimen margin Superior (S) margin Medial (M) margin Lateral (L) margin Inferior (I) margin Deep-Posterior (DP) margin Anterior-Skin (AS) margin BMC Cancer 2009, 9:254 http://www.biomedcentral.com/1471-2407/9/254 Table 7: Summary of the total number of individual instances in which any one of the designated BCS specimen margin sites was positive or was positive/close from the pathology report of the 204 BCS cases Number of instances in which there was a positive BCS specimen margin Histopathology of each positive BCS specimen margin Number of instances in which there was a positive/close BCS specimen margin Histopathology of each positive/close BCS specimen margin 3 5 3 5 4 0 3 8 4 6 8 0 2 IDC, 1 ACC 2 IDC, 2 ILC, 1 DCIS 1 IDC, 1 ILC, 1 DCIS 2 IDC, 2 ILC, 1 DCIS 2 IDC, 1 ILC, 1 ACC not applicable 2 IDC, 1 ACC 5 IDC, 2 ILC, 1 DCIS 2 IDC, 1 ILC, 1 DCIS 2 IDC, 2 ILC, 2 DCIS 4 IDC, 1 ILC, 2 DCIS, 1 ACC not applicable BCS, breast-conserving surgery; IDC, invasive ductal carcinoma; ILC, invasive lobular carcinoma; DCIS ductal carcinoma in situ; ACC, adenoid cystic carcinoma supported by the work of other investigators [30,69-71], that adjacent multifocal disease within the same quadrant of the affected breast may contribute to the occurrence of many failed BCS procedures, we can not rule out that some failed BCS procedures may result from suboptimal surgical resection margin assessment techniques that fail to recognized positive or close margins on the BCS speci- men itself. Nevertheless, in regards to the issue of the potential presence of adjacent multifocal disease within the same quadrant of the affected breast upon which the BCS procedure is being performed, obtaining nine stand- ardized re-resection margin specimens, as proposed in our current study, allows one to systematically and methodi- cally assess the adjacent breast tissue for multifocality within the same quadrant of the affected breast and may allow one to select out those individuals who would be better suited for completion mastectomy who had addi- tional multifocal disease within the same quadrant that would have otherwise been unrecognized by traditional resectional techniques for BCS that did not routinely uti- lize some sort of re-resection margin technique. This line of reasoning does not disagree with the well-held contention that most breast cancers recurrences within the breast after BCS occur within the same quadrant of the affected breast and not within a different quadrant of the affected breast [30,70,72-76]. Instead, our line of reason- ing agrees with this well-held contention since it is our belief that such recurrences within the affected breast rep- resent a failure of BCS, in the sense that there is a failure to recognize adjacent multifocality located adjacent to the primary tumor mass rather than a failure of the traditional Table 8: Summary of the total number of individual instances in which any one of the designated nine standardized re-resection margin sites was positive for disease from the pathology report of the 204 BCS cases Number of instances in which there was a positive re-resections margin Histopathology of each positive re-resection margin Re-resection margin Superior (S) re-resection margin Superior-Medial (SM) re-resection margin Superior-Lateral (SL) re-resection margin Medial (M) re-resection margin Lateral (L) re-resection margin Inferior (I) re-resection margin Inferior-Medial (IM) re-resection margin Inferior-Lateral (IL) re-resection margin Deep-Posterior (DP) re-resection margin 5 4 4 5 5 7 3 7 3 2 IDC, 2 DCIS, 1 ACC 1 IDC, 2 DCIS, 1 ACC 1 IDC, 1 ILC, 2 DCIS 3 IDC, 2 DCIS 3 IDC, 2 DCIS 2 IDC, 5 DCIS 2 IDC, 1 DCIS 3 IDC, 4 DCIS 2 DCIS, 1 ACC BCS, breast-conserving surgery; IDC, invasive ductal carcinoma; ILC, invasive lobular carcinoma; DCIS ductal carcinoma in situ; ACC, adenoid cystic carcinoma Page 13 of 23 (page number not for citation purposes)