Advances in intraoperative margin assessment for solid tumors: Toward a new era of personalized precision surgery

The accurate determination of surgical margin status remains a core challenge in the curative surgery of solid tumors. Conventional methods relying on intraoperative frozen sections and empirical surgeon judgment often fall short due to insufficient spatial resolution, an inability to detect molecular residues, and inherent subjectivity. These limitations fail to meet the demands of personalized precision surgery. Recent breakthroughs in multimodal intraoperative assessment technologies are driving a paradigm shift from empirical resection towards molecular navigation: advanced imaging techniques enable dynamic visualization of anatomical boundaries; fluorescence and spectral technologies provide real-time biological margin navigation by capturing tissue-specific molecular fingerprints; mass spectrometry, leveraging metabolomic signatures, can provide alerts rapidly for histologically negative yet high-risk margins; and molecular profiling methods further decode potential biological boundaries defined by spatial immune microenvironment gradients and genomic alterations. Together, these technologies are elevating the evaluation standard from "morphologically negative" to "molecularly safe" delivering unprecedented precision for surgical decision-making. However, critical bottlenecks for clinical translation persist, including high costs, a lack of cross-platform standardization, and insufficient multimodal integration. Future advancements will require leveraging complementary technological strengths, developing AI-driven automated analysis systems, and accelerating research into portable devices. An individualized margin assessment framework grounded in tumor biology and treatment response will establish a new foundation for optimizing long-term patient survival and functional preservation.