1. Intraoperative Tissue Identification Using Rapid Evaporative Ionization Mass Spectrometry Tyler Daly Biomedical Engineering 11/10/2015

2.  Introduction  What is REIMS?  Case Study & Results  Discussion Overview

3.  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

4.  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

5.  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)

6. ***REIMS converts tissue components into gas-phase ionic species that are then sent through mass spectrometric analysis***

7.  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

8.  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

11.  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

12.  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

13.  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

14. Questions?