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![Page 1: Intraoperative Tissue Identification Using Rapid Evaporative Ionization Mass Spectrometry Tyler Daly Biomedical Engineering 11/10/2015.](https://reader035.fdocuments.in/reader035/viewer/2022062410/5697c0111a28abf838ccb740/html5/thumbnails/1.jpg)
Intraoperative Tissue Identification Using Rapid Evaporative Ionization
Mass SpectrometryTyler Daly
Biomedical Engineering11/10/2015
![Page 2: Intraoperative Tissue Identification Using Rapid Evaporative Ionization Mass Spectrometry Tyler Daly Biomedical Engineering 11/10/2015.](https://reader035.fdocuments.in/reader035/viewer/2022062410/5697c0111a28abf838ccb740/html5/thumbnails/2.jpg)
Introduction What is REIMS? Case Study & Results Discussion
Overview
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More than 300,000 new cancer cases diagnosed in the UK yearly
1.8 million diagnostic, curative, or palliative surgical procedures performed as means of treatment Problem: using “margin with clearances”- surgeons cut
away excess healthy tissue Cosmetic success of surgery depends on how much excess
healthy tissue is removed Ex: 20% of breast cancer patients who receive lumpectomies
require further surgery to clear positive margins.
Introduction
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Problem: re-excision not always possible in soft tissue areas of the body
Accurate tumor invasion assessed accurately through multiple histological analyses in postoperative phases
In uncertain surgical cases, removed tissue gets sent to pathology labs and analyzed, while patient is under general anesthesia Expensive and time consuming (20-30 minutes
minimum)
Introduction
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Almost no technologies is current clinical practice to assist surgeons on accurate cancer tissue clearance in real-time
Rapid evaporative ionization mass spectrometry (REIMS)- real-time characterization of human tissue in vivo Analysis of the “smoke” released during
electrosurgical dissection Pairing REIMS technology with electrosurgery for tissue
diagnostics known as the intelligent knife (iKnife)
Solution: REIMS (and the iKnife)
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***REIMS converts tissue components into gas-phase ionic species that are then sent through mass spectrometric analysis***
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Before the case study took place, iKnife data was collected ex vivo (tissue dissected and tested outside of the body) to create a reference library of data for the in vivo (tissue analyzed within the body) testing
Data ranged from benign to malignant tumors of gastric, colonic, hepatic, breast, lung, and brain tissue sample
Case Study
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Multicenter observational study at three hospitals in Hungary (May 1, 2010 – February 29, 2012)
393 patients recruited Cancers ranging from gastric, colorectal, liver,
breast, lung, and brain
Case Study
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Mass spectrometric tissue identification matched postoperative histopathology in 96.2% of the cases 15 cases conflicted pre/postoperative tissue
identification
The REIMS-iKnife technique was able to correctly identify 11 tissue types and correctly identify 9 of the cases to be malignant or benign (81.8% accuracy) For the two cases that were incorrect, it was later
revealed through further exploration that the disease present was actually a case of Chrohn’s disease
The final case was inconclusive
Results
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Data collected from the case study provides concrete evidence that REIMS-iKnife technology is a viable option for real-time tissue analysis This would solve many problems such as:
The need to go in for secondary surgery The removal of excess healthy tissue The need to hold patients under general
anesthetics for extended periods of time
Discussion
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Many factors limit the potential of growth of other means of accurate tissue characterization (potential toxicity and pharmacokinetics, limitations of information provided from infrared dyes and Raman spectroscopy, etc)
REIMS- iKnife technology has room to grow, as it already can distinguish between types of cancer and their dangers
Cost effective/Time saving
Discussion
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Questions?