Intraoperative Tissue Identification Using Rapid Evaporative Ionization Mass Spectrometry
Intraoperative Tissue Identification Using Rapid Evaporative Ionization Mass Spectrometry
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DOI：
10.1126/scitranslmed.3005623
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发表时间：
2013-07-17
影响因子：
17.1
通讯作者：
Takats, Zoltan
中科院分区：
文献类型：
--
作者：
Balog, Julia;Sasi-Szabo, Laszlo;Takats, Zoltan
快速蒸发电离质谱法（REIMS）是一种新兴技术，通过分析电外科切割过程中释放的气溶胶（“烟雾”），可以对人体组织进行近实时表征。将REIMS技术与电外科手术结合用于组织诊断被称为智能刀（iKnife）。本研究旨在通过将其应用于离体新鲜人体组织样本的分析来验证该技术，并证明在手术环境中转化为体内实时使用。在实验室中分析了来自302名患者的各种组织样本，产生了1624个癌性和1309个非癌性数据库条目。然后，该技术被转移到手术室，在那里该设备与现有的电外科设备连接，在总共81次切除过程中收集数据。质谱数据进行了分析，使用多元统计方法，包括主成分分析（PCA）和线性判别分析（LDA），并使用类似的方法实现了光谱识别算法。REIMS方法准确区分不同的组织学和组织病理学组织类型，恶性组织产生其组织病理学亚型特有的化学特征。在100%（全部81例）的研究病例中，通过术中REIMS进行的组织识别与术后组织学诊断相匹配。质谱反映了不同组织学肿瘤类型之间以及原发性和转移性肿瘤之间的脂质组学特征。因此，除了实时诊断信息外，光谱还提供了关于可能在癌症中具有机械重要性的不同肿瘤生物化学的额外信息。
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.