{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T05:11:38Z","timestamp":1789017098377,"version":"build-2803163510"},"reference-count":33,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100024838","name":"Samsung Medical Center","doi-asserted-by":"crossref","award":["SMX126005"],"award-info":[{"award-number":["SMX126005"]}],"id":[{"id":"10.13039\/501100024838","id-type":"DOI","asserted-by":"crossref"}]},{"award":["SMX126005"],"award-info":[{"award-number":["SMX126005"]}],"id":[{"id":"https:\/\/ror.org\/05a15z872","id-type":"ROR","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003052","name":"Ministry of Trade, Industry and Energy","doi-asserted-by":"publisher","award":["RS-2025-09452988"],"award-info":[{"award-number":["RS-2025-09452988"]}],"id":[{"id":"10.13039\/501100003052","id-type":"DOI","asserted-by":"publisher"}]},{"award":["RS-2025-09452988"],"award-info":[{"award-number":["RS-2025-09452988"]}],"id":[{"id":"https:\/\/ror.org\/008nkqk13","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Ministry of Health and Welfare","award":["RS-2024-00437038"],"award-info":[{"award-number":["RS-2024-00437038"]}]},{"award":["RS-2024-00437038"],"award-info":[{"award-number":["RS-2024-00437038"]}],"id":[{"id":"https:\/\/ror.org\/00vxgjw72","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Curr. Oncol.","Current Oncology"],"abstract":"<jats:p>Background\/Objectives: Myxofibrosarcoma (MFS) shows infiltrative fascial extensions that complicate margin achievement and drive local recurrence. We evaluated whether intraoperative ultrasound guidance improves negative margin achievement and oncological outcomes compared with conventional excision. Methods: In this retrospective cohort study at a single tertiary referral center, patients with MFS underwent conventional excision (2008\u20132013; n = 15) or ultrasound-guided excision (2014\u20132024; n = 50; primary comparative analysis n = 47 after excluding three patients). The primary outcome was negative margin achievement; secondary outcomes were overall survival (OS), local recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS). Exploratory matching-adjusted indirect comparisons (MAICs) were performed against seven published international MFS cohorts. Results: Overall R0 (negative) margin rates did not differ between cohorts (97.9% vs. 93.3%; p = 0.428). Among R0 margins, however, a wide clearance (R0-wide, \u22651 mm) was more frequent in the US-guided cohort, whereas R0-close (&lt;1 mm) margins predominated after conventional excision (R0-wide 83.0% vs. 46.7%; odds ratio 5.38, 95% CI 1.30\u201323.73; p = 0.014). Median follow-up was 49 months; five-year OS, LRFS, and DMFS were 97.5%, 94.3%, and 83.7%. In the internal historical comparison, LRFS was directionally higher with ultrasound guidance (94.3% vs. 68.2%; HR 0.26; p = 0.059). In MAICs, LRFS favored the US-guided cohort in all five comparisons and OS in two of four. Conclusions: Intraoperative ultrasound guidance was associated with a higher rate of wide (R0-wide, \u22651 mm) negative margins and favorable local disease control in MFS; whether wider microscopic clearance itself improves local control requires prospective multicenter evaluation.<\/jats:p>","DOI":"10.3390\/curroncol33090538","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T17:25:56Z","timestamp":1788542756000},"page":"538","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Higher Negative Margin Rates with Intraoperative Ultrasound-Guided Excision for Myxofibrosarcoma: A Single-Center Cohort Study with External Comparisons"],"prefix":"10.3390","volume":"33","author":[{"given":"Youngkeun","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3775-5972","authenticated-orcid":false,"given":"Sujin","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, 115 Irwon-ro, Gangnam-gu, Seoul 06355, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang Ah","family":"Chi","sequence":"additional","affiliation":[{"name":"Biomedical Statistics Center, Data Science Research Institute, Research Institute for Future Medicine, Samsung Medical Center, 115 Irwon-ro, Gangnam-gu, Seoul 06355, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung Wook","family":"Seo","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, School of Medicine, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3074","DOI":"10.1245\/s10434-022-12868-4","article-title":"Epidemiologic Survey of Myxofibrosarcoma Using Data from the Bone and Soft Tissue Tumor Registry in Japan","volume":"30","author":"Kamio","year":"2023","journal-title":"Ann. Surg. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1007\/s00256-008-0542-4","article-title":"MRI and Histological Evaluation of the Infiltrative Growth Pattern of Myxofibrosarcoma","volume":"37","author":"Kaya","year":"2008","journal-title":"Skelet. Radiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1007\/s00256-014-1992-5","article-title":"An Analysis of Factors Related to the Tail-Like Pattern of Myxofibrosarcoma Seen on MRI","volume":"44","author":"Kikuta","year":"2015","journal-title":"Skelet. Radiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1111\/ans.18320","article-title":"Oncologic Outcomes in Myxofibrosarcomas: The Role of a Multidisciplinary Approach and Surgical Resection Margins","volume":"93","author":"Rhee","year":"2023","journal-title":"ANZ J. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1245\/s10434-010-1341-4","article-title":"Myxofibrosarcoma: Prognostic Factors and Survival in a Series of Patients Treated at a Single Institution","volume":"18","author":"Sanfilippo","year":"2011","journal-title":"Ann. Surg. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.21037\/atm-21-3587","article-title":"Analysis of Prognostic Factors in 171 Patients with Myxofibrosarcoma of the Trunk and Extremities: A Cohort Study","volume":"9","author":"Liu","year":"2021","journal-title":"Ann. Transl. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1245\/s10434-012-2572-3","article-title":"Prognostic Factors and Outcomes of Patients with Myxofibrosarcoma","volume":"20","author":"Hornicek","year":"2013","journal-title":"Ann. Surg. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1097\/SLA.0b013e3181cf87fa","article-title":"Extremity Soft Tissue Sarcoma in a Series of Patients Treated at a Single Institution: Local Control Directly Impacts Survival","volume":"251","author":"Gronchi","year":"2010","journal-title":"Ann. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1007\/s00423-023-03002-3","article-title":"Ten Recommendations for Sarcoma Surgery: Consensus of the Surgical Societies Based on the German S3 Guideline \u201cAdult Soft Tissue Sarcomas\u201d","volume":"408","author":"Jakob","year":"2023","journal-title":"Langenbeck\u2019s Arch. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1007\/s00256-012-1563-6","article-title":"Myxofibrosarcoma: Prevalence and Diagnostic Value of the \u201cTail Sign\u201d on Magnetic Resonance Imaging","volume":"42","author":"Lefkowitz","year":"2013","journal-title":"Skelet. Radiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"9171","DOI":"10.1245\/s10434-021-10242-4","article-title":"Temporizing Wound VAC Dressing Until Final Negative Margins Are Achieved Reduces Myxofibrosarcoma Local Recurrence","volume":"28","author":"Fourman","year":"2021","journal-title":"Ann. Surg. Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2627","DOI":"10.1016\/j.ejso.2021.06.017","article-title":"The Importance of Clear Margins in Myxofibrosarcoma: Improving Local Control by Means of Staged Resection and Reconstruction","volume":"47","author":"Berner","year":"2021","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1791","DOI":"10.1002\/jso.26181","article-title":"Intraoperative Ultrasonography-Guided Surgery for Malignant Soft Tissue Tumor","volume":"122","author":"Takeuchi","year":"2020","journal-title":"J. Surg. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1016\/j.jval.2012.05.004","article-title":"Matching-Adjusted Indirect Comparisons: A New Tool for Timely Comparative Effectiveness Research","volume":"15","author":"Signorovitch","year":"2012","journal-title":"Value Health"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Guyot, P., Ades, A., Ouwens, M.J., and Welton, N.J. (2012). Enhanced Secondary Analysis of Survival Data: Reconstructing the Data from Published Kaplan-Meier Survival Curves. BMC Med. Res. Methodol., 12.","DOI":"10.1186\/1471-2288-12-9"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"830879","DOI":"10.1155\/2012\/830879","article-title":"Prognostic and Survival Factors in Myxofibrosarcomas","volume":"2012","author":"Dewan","year":"2012","journal-title":"Sarcoma"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e544","DOI":"10.1093\/oncolo\/oyad332","article-title":"Localized Myxofibrosarcoma: A Retrospective Analysis of Primary Therapy and Prognostic Factors in 134 Patients in a Single Institution","volume":"29","author":"Pogkas","year":"2024","journal-title":"Oncologist"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"12232","DOI":"10.1038\/s41598-024-63035-6","article-title":"Clear Surgical Margins as a Prognostic Indicator for Disease Recurrence, with No Impact on Survival Rates in Patients with Myxofibrosarcoma","volume":"14","author":"Apostolopoulos","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1002\/jso.26277","article-title":"A Clinicopathologic Examination of Myxofibrosarcoma. Do Surgical Margins Significantly Affect Local Recurrence Rates in This Infiltrative Sarcoma Subtype?","volume":"123","author":"Dadrass","year":"2021","journal-title":"J. Surg. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1016\/j.otsr.2020.04.017","article-title":"Tumor-Associated Mortality and Prognostic Factors in Myxofibrosarcoma\u2014A Retrospective Review of 109 Patients","volume":"106","author":"Gilg","year":"2020","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1016\/j.ejso.2021.10.010","article-title":"Safe-Margin Surgery by Plastic Reconstruction in Extremities or Parietal Trunk Soft Tissue Sarcoma: A Tertiary Single Centre Experience","volume":"48","author":"Binder","year":"2022","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e570","DOI":"10.3928\/01477447-20110714-03","article-title":"Intraoperative Ultrasound Assistance for Excision of Impalpable Musculoskeletal Soft Tissue Tumors","volume":"34","author":"Farfalli","year":"2011","journal-title":"Orthopedics"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Osman, Y., Dulude, J.-P., Leblond, F., and Gervais, M.-K. (2025). A Comprehensive Review of Margin Identification Methods in Soft Tissue Sarcoma. Curr. Oncol., 32.","DOI":"10.3390\/curroncol32120703"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1844816","DOI":"10.1155\/2021\/1844816","article-title":"Oncological Outcomes in Patients with Appendicular Myxofibrosarcomas: A Retrospective Study","volume":"2021","author":"Lee","year":"2021","journal-title":"J. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1016\/j.ejso.2016.03.026","article-title":"The Width of Resection Margins Influences Local Recurrence in Soft Tissue Sarcoma Patients","volume":"42","author":"Kainhofer","year":"2016","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1200\/JCO.2017.74.6941","article-title":"Analysis of Margin Classification Systems for Assessing the Risk of Local Recurrence After Soft Tissue Sarcoma Resection","volume":"36","author":"Gundle","year":"2018","journal-title":"J. Clin. Oncol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1723","DOI":"10.1016\/j.ejso.2022.01.003","article-title":"Treatment Strategies and Outcomes of Primary Myxofibrosarcomas in a Large Patients Cohort","volume":"48","author":"Radaelli","year":"2022","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"101485","DOI":"10.1016\/j.adro.2024.101485","article-title":"Myxofibrosarcoma: Outcomes, Prognostic Factors, and Role of Neoadjuvant Radiation Therapy","volume":"9","author":"Abdou","year":"2024","journal-title":"Adv. Radiat. Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Sam\u00e0, L., Rodda, G.A., Ruspi, L., Sicoli, F., D\u2019Amato, V., Renne, S.L., Laffi, A., Baldaccini, D., Clerici, E., and Navarria, P. (2024). Mesenchymal Tumor Management: Integrating Surgical and Non-Surgical Strategies in Different Clinical Scenarios. Cancers, 16.","DOI":"10.3390\/cancers16172965"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1002\/jso.23708","article-title":"Impact of Infiltrative Growth on the Outcome of Patients with Undifferentiated Pleomorphic Sarcoma and Myxofibrosarcoma","volume":"110","author":"Iwata","year":"2014","journal-title":"J. Surg. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1245\/s10434-011-1876-z","article-title":"Unplanned Excision of Soft Tissue Sarcoma Results in Increased Rates of Local Recurrence Despite Full Further Oncological Treatment","volume":"19","author":"Qureshi","year":"2012","journal-title":"Ann. Surg. Oncol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1007\/s12306-017-0475-y","article-title":"Impact of Residual Disease After \u201cUnplanned Excision\u201d of Primary Localized Adult Soft Tissue Sarcoma of the Extremities: Evaluation of 452 Cases at a Single Institution","volume":"101","author":"Bianchi","year":"2017","journal-title":"Musculoskelet. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1093\/jjco\/hyx123","article-title":"Analysis of the Patients with Soft Tissue Sarcoma Who Received Additional Excision After Unplanned Excision: Report from the Bone and Soft Tissue Tumor Registry in Japan","volume":"47","author":"Nakamura","year":"2017","journal-title":"Jpn. J. Clin. Oncol."}],"container-title":["Current Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1718-7729\/33\/9\/538\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T04:39:56Z","timestamp":1789015196000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1718-7729\/33\/9\/538"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,4]]},"references-count":33,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["curroncol33090538"],"URL":"https:\/\/doi.org\/10.3390\/curroncol33090538","relation":{},"ISSN":["1718-7729"],"issn-type":[{"value":"1718-7729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,4]]}}}