Evaluating Marrow Margins for Resection of Osteosarcoma

Meyer, Mark S.; Spanier, Suzanne S.; Moser, Michael W.; Scarborough, Mark T.

doi:10.1097/00003086-199906000-00022

Cited by 19 publications

(15 citation statements)

References 18 publications

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“…The findings from Meyer et al's study [8] hold true in the current study. What has changed in the time since that study, however, is the acceptance of smaller margins.…”

Section: Discussionsupporting

confidence: 80%

“…Moreover, the assessment of frozen specimens may be an unnecessary intraoperative procedure when gross split specimen assessment is used. These results are supported by the work from Meyer et al [8], the only other evaluation of this practice in the literature. In this study, there were no positive frozen sections in patients after the era of preoperative evaluation of tumor extent with MRI, but there were three in the group that did not have MRI, one of which was a false-positive.…”

Section: Discussionsupporting

confidence: 80%

“…Based on the results from the current study and the study from Meyer et al [8], a reasonable approach is for surgeons to rely on intraoperative pathologic inspection of the gross specimen alone for assessment of bone marrow margins in cases in which this examination is feasible and provides a straightforward result. If a particular margin is questionable, then certainly specific frozen sections of that area may be performed, but the routine use of bone marrow frozen section analysis can be eliminated when a gross split specimen is being examined.…”

Section: Discussionmentioning

confidence: 96%

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Frozen Section versus Gross Examination for Bone Marrow Margin Assessment During Sarcoma Resection

Anderson

Miller

Nostrand

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Complete resection is critical for local control of primary bone sarcomas. Intraoperative consultation, including frozen section of bone marrow margins, frequently is used to aid in this goal. Questions/purposes We therefore sought to determine (1) how often intraoperative frozen section of a bone marrow margin correlates with inspection of the gross split specimen and, in cases of a discrepancy, what clinical decision is made; and (2) how well each of these assessments agrees with the final pathologic assessment of a marrow margin. Methods One hundred ninety-five bone marrow margins from 142 patients (74 males, 68 females; mean age, 12.8 years) with primary sarcomas who underwent resection and had frozen section(s) performed on a bone marrow margin were analyzed. Agreement between frozen section interpretation and inspection of the split gross specimen was analyzed in their application to determine adequacy of the bone marrow margin intraoperatively. Results In 179 margins, the frozen section agreed with the gross inspection decision (95.6% negative agreement, 38.5% positive agreement). Decisions regarding further surgical action in all 16 instances of disagreement were based on inspection of the split gross specimen, and the frozen section was disregarded. In 195 of 195 margins, intraoperative decisions were made based on gross specimen inspection.

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“…The findings from Meyer et al's study [8] hold true in the current study. What has changed in the time since that study, however, is the acceptance of smaller margins.…”

Section: Discussionsupporting

confidence: 80%

Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 96%

See 1 more Smart Citation

Frozen Section versus Gross Examination for Bone Marrow Margin Assessment During Sarcoma Resection

Anderson

Miller

Nostrand

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…Meyer et al [5] evaluated the reliability of preoperative T1-weighted MRI to determine the osteotomy plane for safe resection margins in patients with osteosarcoma. They reported that MRI is a dependable technique for planning satisfactory resection margins without the need for intraoperative frozen section analysis.…”

Section: Discussionmentioning

confidence: 99%

“…T1-weighted MRI has previously been evaluated in determining the osteotomy level before undertaking resection for osteosarcomas [5][6][7][8] and is reported to accurately measure intra-osseous extent such that osteotomies can be performed 2-3 cm distal to osteosarcomas in the lower limb [9,10].…”

Section: Introductionmentioning

confidence: 99%

Accuracy of magnetic resonance imaging in planning the osseous resection margins of bony tumours in the proximal femur: based on coronal T1-weighted versus STIR images

et al. 2014

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The utility of intraoperative marrow margin frozen section in extremity bone sarcoma resection

Gazendam,

Clever,

Zhang

et al. 2024

Journal of Surgical Oncology

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Background and ObjectivesIntraoperative frozen section analysis is commonly used to evaluate marrow margins during extremity bone sarcoma resections, but its efficacy in the era of magnetic resonance imaging is debated. This study aimed to compare the accuracy of intraoperative frozen section assessment with final pathology, assess its correlation with gross intraoperative margin assessment, and evaluate its impact on surgical decision making.MethodsConsecutive patients undergoing extremity bone sarcoma resections from 2010 to 2022 at a single sarcoma center were included. Intraoperative frozen section and gross margin assessments were compared to final pathology using positive predictive values (PPV) and negative predictive values (NPV). Changes in surgical decisions due to positive intraoperative margins were recorded.ResultsOf 166 intraoperative frozen section marrow margins, four were indeterminant/positive, with two false positive/indeterminant findings and two false negatives compared to final pathology. Gross intraoperative assessment had no false positives and two false negatives. Frozen section analysis yielded a PPV of 50% (95% confidence interval [CI]: 16%–84%) and NPV of 98.8% (95% CI: 97%–100%), while gross assessment had a PPV of 100% (95% CI: 16%–100%) and NPV of 98.8% (95% CI: 97%–100%). Positive frozen section margins led to additional resections in three of four cases.ConclusionsIntraoperative frozen section analysis did not offer added clinical value beyond gross margin assessment in extremity bone sarcoma resections. It exhibited a low PPV and led to unnecessary additional resections. Gross intraoperative assessment proved adequate for margin evaluation, potentially saving time and resources.

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Evaluating Marrow Margins for Resection of Osteosarcoma

Cited by 19 publications

References 18 publications

Frozen Section versus Gross Examination for Bone Marrow Margin Assessment During Sarcoma Resection

Frozen Section versus Gross Examination for Bone Marrow Margin Assessment During Sarcoma Resection

Accuracy of magnetic resonance imaging in planning the osseous resection margins of bony tumours in the proximal femur: based on coronal T1-weighted versus STIR images

The utility of intraoperative marrow margin frozen section in extremity bone sarcoma resection

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