Intraoperative Peripheral Frozen Margin Assessment in Soft Tissue Sarcoma.

Abstract

Background/objectives: Intraoperative peripheral margin sampling in soft tissue sarcoma (STS) is a routine practice among musculoskeletal oncologists. Practice patterns are variable, and evidence to support it is lacking. Rates of peripheral margin sampling at our institution were analyzed in addition to its clinical utility and cost-effectiveness.

Methods: Peripheral margin sampling patterns at a tertiary sarcoma center were retrospectively evaluated. Concordance between peripheral margins and final pathology was assessed using McNemar's test and κ Coefficient. Clinical outcomes were compared, and a cost-utility analysis was performed.

Results: A total of 179 patients were included. 66% had peripheral margins sampled of which 23% had frozen margins analyzed. Ten patients had positive margins (5.5% of all patients; 8.4% in those with margins sampled) and R1 margins on the final tumor specimen were identified in 15 patients (8.4%). There were no R2 resections. Three patients underwent repeat surgical resection (20%). Three patients with R1 resections had negative peripheral margins sampled, suggesting falsely reassuring peripheral margins. Peripheral margin sampling averaged $5000/patient.

Conclusions: Routine peripheral margin sampling in STS resection is of questionable utility with added cost. Prospective studies are warranted to determine the optimal approach to surgical margin assessment.