Novel surgical implement allows for rapid diagnosis of cancerous tissue using MS to aid surgeons in identifying and removing diseased tissue during surgery.
Researchers from Imperial College London (London, UK) and the University of Debrecen (Debrecen, Hungary) have developed a tool that can accelerate surgical procedures by providing almost immediate information on the tissue they are considering removing. The iKnife (“intelligent knife”) uses rapid evaporative ionization-MS to analyze the pathological status of that tissue. The development of this novel technology is predicted to remove the risk of removing healthy tissue and the risk of current diagnostic procedures involving fluorescent dyes. The use of the iKnife has the potential to speed up surgical procedures by bypassing the transfer of samples for analysis by pathologists.
The current diagnosis of tissue during surgery involves sending samples to pathologists several times throughout the surgical procedure, and still poses a risk of removing healthy tissue. The iKnife, which has been tested in mice and ex vivo on human tissue, cuts tissue using an electric current, producing smoke filled with ionized molecules from that tissue which is then sent for analysis by MS to diagnose histological and histopathological tissue. The iKnife is small and can be attached to the end of the electrosurgical knife, which addresses initial concerns raised by surgeons regarding the use of large technologies in the operating room.
The iKnife was proved to consistently and accurately identify cancerous tissue in patients. The results were compared to tissue spectra and a pathologist’s expert diagnosis. Furthermore, the iKnife produced spectra that could be analyzed to distinguish between tumor types, as well as biochemical aspects of tumor cells that are involved in mechanisms of interest in cancer cells. While the iKnife allows for rapid diagnosis of cancerous and non-cancerous tissue, a pathologist’s expertise is still required for prognosis.
The iKnife is due to be further developed through characterizing more molecules and their MS profiles to allow for further distinction between tumor types. The iKnife still requires a mass spectrometer to analyze data and, therefore, future directions will include shrinking mass spectrometers to allow for on-the-spot diagnosis in the operating room. In addition, further analysis on how the iKnife affects surgical outcomes, such as time of procedure and the amount of unaffected healthy tissue, will direct its development.
Source: Balog J, Sasi-Szabó, Kinross J et al. Intraoperative tissue tdentification using rapid evaporative ionization mass spectrometry. Sci. Transl. Med. 5(194), 194ra93 (2013).