Comparative analysis of intraoperative liquid biopsy in tumor margin detection during hepatobiliary and gastrointestinal cancer surgeries

Accurate intraoperative tumor margin assessment remains a major challenge in hepatobiliary and gastrointestinal cancer surgery, leading to residual disease and increased recurrence risk. Therefore, it is of interest to evaluate the diagnostic performance of intraoperative liquid biopsy (ctDNA, CTCs and exosomes) compared with frozen section histopathology in 90 patients undergoing oncological resection. The combined liquid biopsy panel achieved 93.4% sensitivity, 89.7% specificity and 90.3% concordance with R0 margin status, outperforming frozen section analysis in sensitivity. Liquid biopsy also demonstrated a lower re-excision rate and a shorter turnaround time, supporting its feasibility for real-time intraoperative decision-making. Thus, data shows the multi-analyte intraoperative liquid biopsy may enhance margin assessment accuracy and represent a promising adjunct to conventional frozen section evaluation.