sábado, 20 de julio de 2013

Intraoperative Tissue Identification Using Rapid Evaporative Ionization Mass Spectrometry

Intraoperative Tissue Identification Using Rapid Evaporative Ionization Mass Spectrometry


Sci Transl Med
Vol. 5, Issue 194, p. 194ra93
Sci. Transl. Med. DOI: 10.1126/scitranslmed.3005623
  • Research Article
CANCER DIAGNOSTICS

Intraoperative Tissue Identification Using Rapid Evaporative Ionization Mass Spectrometry

  1. Zoltán Takáts3,
+ Author Affiliations
  1. 1MediMass Ltd., 1033 Budapest, Hungary.
  2. 2Institute of Surgery, Medical and Health Science Centre, University of Debrecen, 4032 Debrecen, Hungary.
  3. 3Computational and Systems Medicine, Department of Surgery and Cancer, Faculty of Medicine, Sir Alexander Fleming Building, Imperial College London, London SW7 2AZ, UK.
  4. 4Section of Biosurgery and Surgical Technology, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, QEQM, St. Mary’s Hospital, London W2 1NY, UK.
  5. 5Institute of Pathology, Medical and Health Science Centre, University of Debrecen, 4032 Debrecen, Hungary.
+ Author Notes
  • * These authors contributed equally to this work.
  1. Corresponding author. E-mail: z.takats@imperial.ac.uk (Z.T.); j.nicholson@imperial.ac.uk (J.K.N.)

Abstract

Rapid evaporative ionization mass spectrometry (REIMS) is an emerging technique that allows near–real-time characterization of human tissue in vivo by analysis of the aerosol (“smoke”) released during electrosurgical dissection. The coupling of REIMS technology with electrosurgery for tissue diagnostics is known as the intelligent knife (iKnife). This study aimed to validate the technique by applying it to the analysis of fresh human tissue samples ex vivo and to demonstrate the translation to real-time use in vivo in a surgical environment. A variety of tissue samples from 302 patients were analyzed in the laboratory, resulting in 1624 cancerous and 1309 noncancerous database entries. The technology was then transferred to the operating theater, where the device was coupled to existing electrosurgical equipment to collect data during a total of 81 resections. Mass spectrometric data were analyzed using multivariate statistical methods, including principal components analysis (PCA) and linear discriminant analysis (LDA), and a spectral identification algorithm using a similar approach was implemented. The REIMS approach differentiated accurately between distinct histological and histopathological tissue types, with malignant tissues yielding chemical characteristics specific to their histopathological subtypes. Tissue identification via intraoperative REIMS matched the postoperative histological diagnosis in 100% (all 81) of the cases studied. The mass spectra reflected lipidomic profiles that varied between distinct histological tumor types and also between primary and metastatic tumors. Thus, in addition to real-time diagnostic information, the spectra provided additional information on divergent tumor biochemistry that may have mechanistic importance in cancer.
Citation: J. Balog, L. Sasi-Szabó, J. Kinross, M. R. Lewis, L. J. Muirhead, K. Veselkov, R. Mirnezami, B. Dezső, L. Damjanovich, A. Darzi, J. K. Nicholson, Z. Takáts, Intraoperative Tissue Identification Using Rapid Evaporative Ionization Mass Spectrometry. Sci. Transl. Med. 5, 194ra93 (2013).

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