A Comprehensive Review of Margin Identification Methods in Soft Tissue Sarcoma.

Area of Science:

• Oncology
• Surgical Pathology
• Medical Imaging

Background:

• Complete tumor resection with negative margins is vital for soft tissue sarcoma (STS) curative treatment and survival.
• Current intraoperative margin assessment methods, like frozen section analysis, have limited accuracy for many STS subtypes.

Purpose of the Study:

• To comprehensively review current and emerging intraoperative techniques for assessing resection margins in STS.
• To evaluate the clinical utility and potential of these novel methods in improving surgical precision and patient outcomes.

Main Methods:

• Systematic literature search of PubMed and PubMed Central (2000-2025).
• Inclusion of studies utilizing fluorescence imaging, spectroscopy, and ultrasound-based modalities for intraoperative margin assessment.
• Evaluation of clinical evidence, accuracy, and potential impact on patient outcomes.

Main Results:

• Indocyanine green (ICG) fluorescence-guided surgery shows the most clinical evidence for reducing positive margins.
• Acridine orange (AO) fluorescence demonstrates potential for decreasing local recurrences but requires more clinical data.
• Raman spectroscopy shows high accuracy in differentiating STS from healthy tissue; further outcome studies are needed.
• Other modalities like DRS, REIMS, OCT, and IOUS show promise but need further validation.

Conclusions:

• Indocyanine green (ICG) fluorescence imaging is closest to widespread clinical adoption for intraoperative margin assessment in STS.
• Several emerging technologies show significant potential to improve surgical precision and reduce positive margins, but require further prospective validation.
• Advancements in intraoperative margin assessment techniques are critical for improving outcomes in soft tissue sarcoma management.