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Related Experiment Video

Updated: May 13, 2025

Intraoperative Assessment of Resection Margins in Oral Cavity Cancer: This is the Way
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Should We Stop Assessing Intraoperative Frozen Section Marrow Margins During Ewing Sarcoma Resection?

Stephen W Chenard1, Akhil Rekulapelli1, Rachel B Mersfelder1

  • 1Vanderbilt University School of Medicine, Nashville, TN, USA.

Clinical Orthopaedics and Related Research
|April 15, 2025
PubMed
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Routine intraoperative frozen section assessment of bone marrow margins during Ewing sarcoma resection offers no survival benefit and may lead to unnecessary bone removal. Surgeons should consider omitting this test unless specific concerns arise, especially with advanced MRI imaging available.

Area of Science:

  • Orthopedic Oncology
  • Pediatric Oncology
  • Surgical Pathology

Background:

  • Ewing sarcoma, a rare pediatric bone cancer, presents diagnostic challenges for intraoperative margin assessment due to chemotherapy-induced bone marrow changes.
  • Prior research has broadly questioned the utility of intraoperative frozen section margin analysis in bone sarcoma resections.
  • The specific accuracy and clinical value of intraoperative bone marrow margin assessment in long bone Ewing sarcoma remain uncharacterized.

Purpose of the Study:

  • To evaluate the accuracy of intraoperative frozen section assessment of bone marrow margins during long bone Ewing sarcoma resection.
  • To determine the impact of positive intraoperative margin assessments on surgical plans.
  • To assess the association between intraoperative margin assessment and oncologic outcomes, including local recurrence, metastasis, and survival.

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Main Methods:

  • Retrospective analysis of 64 patients undergoing primary resection of long bone Ewing sarcoma.
  • Intraoperative frozen sections for bone marrow margins were assessed in 81% of patients.
  • Comparison of frozen section results with final pathology, review of surgical changes, and Kaplan-Meier survival analysis for oncologic outcomes.

Main Results:

  • All intraoperative frozen section assessments were 100% accurate when compared to final pathology; however, all positive frozen sections were false positives.
  • Five of six patients with positive frozen sections underwent unnecessary additional bone resection.
  • No significant differences in local recurrence-free survival, metastasis-free survival, or Ewing sarcoma-specific death-free survival were observed between patients with and without intraoperative margin assessment, or between true negative and false positive margin groups.

Conclusions:

  • Routine intraoperative frozen section assessment of bone marrow margins in long bone Ewing sarcoma resection provides no clear clinical benefit and may result in excessive resection.
  • Intraoperative frozen sections may be warranted only when a surgeon has specific concerns about positive margins.
  • Given advancements in MRI, routine intraoperative frozen section margin assessment is likely unnecessary, potentially saving time and costs.