Dr Randall on Survey Results for Frozen Margin Sampling in Soft Tissue Sarcoma Resection

"The message for the surgical oncologists that might be reading this is there is a good reason to do a sampling peripheral margin when there is a clinical suspicion where that margin will be positive."

R. Lor Randall, MD, FACS, the David Linn Endowed Chair for Orthopedic Surgery, chair of the Department of Orthopedic Surgery, and professor at the University of California, Davis Health, discussed survey findings following a study on intraoperative peripheral frozen section margin sampling in the surgical management of soft tissue sarcoma.

Randall and colleagues first conducted a retrospective study evaluating the use of peripheral margin sampling, and data showed that among evaluable patients with soft tissue sarcoma (n = 179), 66% underwent peripheral margins sampling during resection, and frozen margins were analyzed in 23% of patients. Findings demonstrated that 10 patients (5.5% of all patients; 8.4% of those with margins sampled) had positive margins, and 15 patients (8.4%) had R1 margins on the final tumor specimen.

In a survey later distributed to 320 members of the Musculoskeletal Tumor Society (MSTS), 51% of respondents (n = 108) reported that they routinely perform frozen section analysis of peripheral margins during tumor resections. Those who reported routinely sampling the margins said they generally send 4 to 6 frozen margins.

Randall noted that although frozen section analysis may have utility in specific high-risk clinical scenarios—such as when tumors abut critical structures, neurovascular bundles, or bone—its use as a routine measure in all large tumor resections may not be justified. In cases where there is no clinical suspicion of margin positivity, random sampling of peripheral tissue can frequently yield negative results, which may not alter surgical management but can incur unnecessary cost and pathology workload.

The findings support a more tailored approach to intraoperative margin assessment, Randall explained. Rather than adopting a uniform practice of submitting multiple peripheral margins for frozen section in all cases, he suggested limiting the procedure to instances where intraoperative findings raise concern for close or involved margins. This discretionary model could better balance clinical benefit with resource utilization.

Given the variability in current practice patterns and the absence of definitive data demonstrating improved outcomes with routine peripheral margin sampling, Randall and colleagues suggested that future prospective studies are warranted. These studies could help determine which clinical or radiographic features best predict margin positivity and inform guidelines for selective use of frozen section analysis.