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Intraoperative Peripheral Frozen Margin Assessment in Soft Tissue Sarcoma
Lauren Zeitlinger1, George M Chavez2, Machelle D Wilson3
1Department of Orthopaedic Surgery, University of Pittsburgh Medical Center Central Pennsylvania, Harrisburg, Pennsylvania, USA.
Journal of Surgical Oncology
|November 11, 2024
Summary
Routine peripheral margin sampling in soft tissue sarcoma (STS) surgery offers questionable benefits and adds significant cost. Further research is needed to determine the best methods for assessing surgical margins in STS.
Area of Science:
- Orthopedic Oncology
- Surgical Pathology
Background:
- Intraoperative peripheral margin sampling is common in soft tissue sarcoma (STS) surgery.
- Current evidence supporting its utility and cost-effectiveness is limited.
- Practice patterns for margin sampling vary among surgeons.
Purpose of the Study:
- To analyze the rates of peripheral margin sampling in STS resections.
- To evaluate the clinical utility and cost-effectiveness of this practice.
- To compare intraoperative margin assessment with final pathology results.
Main Methods:
- Retrospective evaluation of peripheral margin sampling patterns at a tertiary sarcoma center.
- Assessment of concordance between peripheral margins and final pathology using statistical tests (McNemar's, κ Coefficient).
- Comparison of clinical outcomes and performance of a cost-utility analysis.
Main Results:
- 179 patients were included; 66% had peripheral margins sampled.
- 10 patients (5.5%) had positive margins; 15 patients (8.4%) had R1 margins on final pathology.
- Peripheral margin sampling averaged $5000 per patient, with some cases showing falsely negative results.
Conclusions:
- Routine peripheral margin sampling in STS resection has questionable clinical utility and incurs additional costs.
- The practice may provide falsely reassuring margin status.
- Prospective studies are necessary to establish optimal surgical margin assessment strategies for STS.
