Researchers from the University of Texas at Austin (UTA) have invented a pen device which quickly and accurately identifies cancerous tissue during surgery. The tool can provide results in around 10 seconds, more than a hundred times faster than some of the best current methods.
The MasSpec Pen, as it is known, provides surgeons with information about which tissue to cut and which to preserve. This enables better treatment by reducing the chance any cancer is left over.
"If you talk to cancer patients after surgery, one of the first things many will say is 'I hope the surgeon got all the cancer out,'" said Livia Schiavinato Eberlin, the designer of the study.
"It's just heart-breaking when that's not the case. But our technology could vastly improve the odds that surgeons really do remove every last trace of cancer during surgery."
The research detailing the development and use of the pen is published in the journal Science Transitional Medicine.
Assessing where a tumour ends and normal tissue begins is a tricky task for surgeons. If too little is removed there is a chance the cancer may return, however, if too much is removed, there is a risk of causing serious damage to patients' organs.
Currently, one of the most advanced methods for determining the edges of a tumour is a technique called Frozen Section Analysis. However, this method is time consuming and can be inaccurate.
During Frozen Section Analysis, each cancer sample must be prepared and examined by a pathologist while the patient is undergoing surgery, a process which can take half an hour or more. This increases the risk of infection and the patient experiencing negative effects from the anaesthesia. In addition, for some types of cancer, this method can give unreliable results in 10 to 20% of cases.
The MasSpec Pen, on the other hand, provides a diagnosis in about 10 seconds and was found to be more than 96% accurate during early tests on tissue removed from 253 cancer patients, even when the tissue was taken from regions with a mixture of normal and cancerous cells.
"Any time we can offer the patient a more precise surgery, a quicker surgery or a safer surgery, that's something we want to do," said James Suliburk, head of endocrine surgery at Baylor College of Medicine and a collaborator on the project. "This technology does all three. It allows us to be much more precise in what tissue we remove and what we leave behind."
To use the device, the surgeon simply places the handheld pen tool against the patient's tissue and triggers an automated analysis using a foot pedal. Within a few seconds, the analysis is completed and the words 'Normal' or 'Cancer' appear on a connected computer screen. For some cancers, a sub-type may even appear.
So how does it work?
All living cells, whether they are normal or cancerous, produce tiny molecules called metabolites which are involved in a multitude of important life processes including generating energy, growth, and removing toxins.
Each cancer type produces a unique set of metabolites which act as a kind of biological fingerprint which the pen can detect. It then sends the data to software which cross-checks the type of metabolite against a database compiled by the team and identifying if the sample contains cancer.
"Cancer cells have dysregulated metabolism as they're growing out of control," said Eberlin. "Because the metabolites in cancer and normal cells are so different, we extract and analyse them with the MasSpec Pen to obtain a molecular fingerprint of the tissue. What is incredible is that through this simple and gentle chemical process, the MasSpec Pen rapidly provides diagnostic molecular information without causing tissue damage."
The technology is currently in its early stages so it won't be commercially available just yet but the team hope to carry out further trials next year.
Dr Áine McCarthy from Cancer Research UK, said: "Exciting research like this has the potential to speed up how quickly doctors can determine if a tumour is cancerous or not and learn about its characteristics. Gathering this kind of information quickly during surgery could help doctors match the best treatment options for patients sooner."