BMC Cancer 2009, 9:254 http://www.biomedcentral.com/1471-2407/9/254 gin, three had two positive BCS specimen margins, and two had three positive BCS specimen margins, thus repre- senting 20 total positive BCS specimen margins among a total of 1224 BCS specimen margin locations evaluated for the 204 BCS cases. Of those 22 cases in which there was a positive or close BCS specimen margin, 17 had one positive/close BCS specimen margin, three had two posi- tive/close BCS specimen margins, and two had three pos- itive/close BCS specimen margins, thus representing 29 total positive/close BCS specimen margins among a total of 1224 BCS specimen margin locations evaluated for the 204 BCS cases. A summary of the findings for all the pos- itive BCS specimen margin cases and the positive or close BCS specimen margin cases is shown in Table 7. For the 164 patients that had an intact tumor at the time of the BCS procedure, the mean microscopic distance of tumor to the closest BCS specimen margin was 0.70 cm (range, 0 to 2.00 cm). Additionally, for those 164 patients that had an intact tumor at the time of the BCS procedure, the mean microscopic distance of tumor to the closest BCS specimen margin was 0.79 cm (range, 0.16 to 2.00 cm) for those classified as having a negative BCS specimen margin (n = 146) as compared to 0.05 cm (range, 0.01 to 0.09) for those classified as having a close BCS specimen margin (n = 7) (P < 0.001). Among the 204 BCS cases, 24 had a positive re-resection margin for one or more of the nine standardized re-resec- tion margin specimens (Table 6). Of those 24 cases in which there was a positive re-resection margin, 15 had one positive re-resection margin, two had two positive re- resection margins, five had three positive re-resection margins, one had four positive re-resection margins, and one had five positive re-resection margins, thus represent- ing 43 total positive re-resection margins among a total of 1836 re-resection margin specimens for the 204 BCS cases. A summary of the findings for all the positive re- resection specimens is show in Table 8. All patients with multiple positive re-resection margins accepted such fur- ther surgical intervention to the affected breast, except for one patient who refused further surgical intervention to the affected breast, as well as refused consideration of any other form of adjuvant therapy. 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 BCS specimen was assessed for all 24 cases in which there was at least one positive re-resection margin (Table 9) and was assessed for all 11 cases in which the BCS specimen had at least one positive/close margin and there was also a positive re- resection margin (Table 10). As is shown in Table 9, of the 24 cases that had at least one positive re-resection margin, only 5 of 24 (20.8%) had completely concordant findings with the margin status of the BCS specimen, while 15 of 24 (62.5%) had completely disconcordant findings and 19 of 24 (79.2%) had some degree of disconcordant find- ings with the margin status of the BCS specimen. As is shown in Table 10, of the 11 patients that had at least one positive/close margin and at least one positive re-resec- tion margin, only 5 of 11 (45.5%) had completely con- cordant findings between the positive/close BCS specimen margin status and the positive re-resection mar- gin status, while 2 of 11 (18.2%) had completely discon- cordant findings and 6 of 11 (54.5%) had some degree of disconcordant findings between the positive/close BCS specimen margin status and the positive re-resection mar- gin status. As shown in Table 11, any potential association of the patient demographic variables and tumor characteristic variables from Table 1 and Table 2 with a "positive final margin status" was assessed by both univariate and multi- variate analyses. For the purpose of these analyses, we broadly defined a "positive final margin status" as having either a positive BCS specimen margin, a close BCS speci- men margin, or an involved (positive) re-resection margin specimen. On univariate analysis, associated DCIS (P = 0.032) and larger tumor size (P = 0.034) were associated with a positive final margin status, whereas invasive lobu- lar carcinoma displayed only a nonsignificant trend (P = 0.095). On multivariate analysis, associated DCIS (P = 0.015) and invasive lobular carcinoma (P = 0.052) were associated with a positive final margin status, whereas larger tumor size displayed only a nonsignificant trend (P = 0.066). Thus, associated DCIS was the only variable associated with a "positive final margin status" by both univariate and multivariate analyses. A description of the frequency of cases undergoing a sub- sequent re-excision breast procedure and the frequency of cases in which residual disease was found within those subsequent re-excision breast procedure specimens is also shown in Table 6. Of those 13 cases in which there was a positive BCS specimen margin, 7 (53.8%) elected to undergo a further re-resection breast procedure, including five undergoing a re-excision BCS procedure, one under- going a completion mastectomy, and one undergoing a re-excision BCS procedure (with further positive margins) followed by a completion mastectomy. Of those 22 cases in which there was a positive or close BCS specimen mar- gin, 11 (50.0%) elected to undergo a further re-excision breast procedure, including six undergoing a re-excision BCS procedure, four undergoing a completion mastec- tomy, and one undergoing a re-excision BCS procedure (with further positive margins) followed by a completion mastectomy. Of those 35 cases in which there was a posi- tive BCS specimen margin, a close BCS specimen margin, or a positive re-resection margin specimen, 16 (45.7%) Page 7 of 23 (page number not for citation purposes)