Intraoperative Peripheral Frozen Margin Assessment in Soft Tissue Sarcoma

Key Takeaways

• Intraoperative frozen margins only changed management in

Paper Info

Journal of Surgical Oncology, Vol 131, 2025, pp 694-698; accepted 10 Sep 2024.

Background

Intra-operative frozen-section assessment of peripheral margins is traditional in musculoskeletal oncology, yet evidence in soft-tissue sarcoma (STS) is sparse.

Objective

Quantify practice patterns, clinical impact, and cost-utility of peripheral-margin sampling (Frozen and Permanent) during STS resection.

Methods

• Retrospective review (2005-2019), multi-institutional

• Inclusion:

  • Extremity or truncal soft tissue sarcoma

  • Primary tumor

  • ≥ 2 years follow up

• Exclusion:

  • Osseous disease

  • Re-excisions

• Pathology charges were evaluated to determine cost of margin assessment

Results

A total of 179 patients were included

• 119 (66%) had peripheral margins sent (frozen or permanent)

  • Frozen margin n = 27 (23%)

  • Permanent margin n = 92 (77%)

    

• Only 1 case in which frozen margins were sent returned positive, resulting in a wider resection at the time of initial surgery

On average, sending margins added approximately $5,000, not including OR time

Conclusion

Routine peripheral-margin sampling provides limited actionable information, modest diagnostic agreement, and substantial cost. A selective, indication-based approach is recommended.

Strengths & Limitations

Strengths: Multi-institution, includes diverse STS subtypes.

Limitations: Retrospective, under-powered for outcome correlations.