iKnife Can Help Determine Presence of Cancerous Cells During Surgery

The molecules in the aerosol or “smoke” that is released during surgery using an electrical knife can help determine if cancer cells are still present in tissues. These results were recently published in Science Translational Medicine.

When patients are undergoing surgery to remove cancer, surgeons try to remove all of the cancerous cells at or near the site of the tumor. Often, tissue around the site of cancer is removed and sent to the pathology lab during the surgery. The pathologist in the laboratory then determines whether cancer cells still exist in the tissues. If cancer cells are in the tissues, the surgeon can remove more tissue and send more samples to the lab in an attempt to remove as much as safely possible. Ultimately, the surgeon attempts to leave no cancer cells behind.

The major issue with sending the tissue samples to the pathologist is that the patient remains under anesthesia during the time the sample is being analyzed. The tissue may be sent several times to the lab, adding even more time the patient and the entire medical team remains in surgery.

Researchers from the United Kingdom recently conducted a clinical study to evaluate a new way in which to identify cancer cells in tissues during surgery. The surgeons used an intelligent knife (iKnife) which utilizes electrosurgical dissection. The aerosol released during the electrosurgery was analyzed for the presence of cancer cells in the tissues. Molecules in the aerosol were analyzed by real-time rapid evaporative ionization mass spectrometry (REIMS).

The study included tissue samples from 81 resections. REIMS correctly identified 100% of the cases studied. In addition, the REIMS correctly differentiated between different biochemical types of cancer. The fact that this is real-time during surgery means that it can save time during the surgical procedure versus sending tissue samples to the pathologist.

These results indicate that REIMS may, in the future, provide an alternative to sending tissues to the pathology lab to identify the presence of cancer cells during surgery. This, in turn, could save substantial amounts of time during the surgical procedure for patients. Further testing to confirm these results is underway.

Reference: Balog J, Sasi-Szabo L, Kinross J, et al. Intraoperative tissue identification using rapid evaporative ionization mass spectrometry. Science Translational Medicine. 2013;5(194): 194ra93. Doi: 10.1126/scitranslmed.3005623.