Dr Randall on the Utility of Intraoperative Peripheral Margin Assessment in Soft Tissue Sarcomas

“We should probably tailor our practice and use [peripheral margin assessment] on a much more discretionary basis.”

R. Lor Randall, MD, FACS, David Linn Endowed Chair for Orthopedic Surgery, chair, Department of Orthopedic Surgery, professor, University of California, Davis, discusses the clinical considerations and cost implications of routine intraoperative frozen section margin sampling in soft tissue sarcoma resection.

Findings from a retrospective study evaluating peripheral margin sampling patterns in soft tissue sarcoma resections (n = 179) found that 66% of patients underwent peripheral margin sampling, including 23% of patients who had frozen sections analyzed. The findings revealed that 10 patients had positive margins (all patients, 5.5%; sample patients, 8.4%), and 15 patients (8.4%) had R1 margins on the final pathology report. Three patients required repeat surgical resection, and 3 patients with R1 resections had negative peripheral margins.

Findings from a survey of members of the Musculoskeletal Tumor Society also showed that 51% of responding members (n = 108) reported intraoperative margins are routinely sent in their clinical practice, and those who send frozen margins general include 4 to 6 specimens.

Given the questionable utility and added cost of peripheral margin sampling, Randall and study coauthors concluded that prospective studies are needed to determine the optimal use of this method. However, he says there is still a good reason to conduct peripheral margin sampling for select patients if there is a clinical suspicion that the margins will be positive. For example, he highlights patients with tumor removal also involves critical structures or is near the bone could be good candidates to select for peripheral margin sampling.

However, broadly conducting peripheral margin sampling across all patients could lead to negative results and added high cost, Randall explains. Using peripheral margin sampling on a more discretionary basis could lead to improved utility within clinical practice for patients with soft tissue sarcoma, he concludes.