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Tytuł:
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The intelligent knife (iKnife) and its intraoperative diagnostic advantage for the treatment of cervical disease.
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Autorzy:
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Tzafetas M; Department of Gut, Metabolism and Reproduction, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London SW7 2DD, United Kingdom.; Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London SW7 2DD, United Kingdom.; Department of Obstetrics and Gynaecology, Imperial College Healthcare NHS Trust, London W2 1NY, United Kingdom.
Mitra A; Department of Gut, Metabolism and Reproduction, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London SW7 2DD, United Kingdom.; Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London SW7 2DD, United Kingdom.; Department of Obstetrics and Gynaecology, Imperial College Healthcare NHS Trust, London W2 1NY, United Kingdom.
Paraskevaidi M; Department of Gut, Metabolism and Reproduction, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London SW7 2DD, United Kingdom.; Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London SW7 2DD, United Kingdom.
Bodai Z; Department of Gut, Metabolism and Reproduction, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London SW7 2DD, United Kingdom.; Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London SW7 2DD, United Kingdom.
Kalliala I; Department of Gut, Metabolism and Reproduction, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London SW7 2DD, United Kingdom.; Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London SW7 2DD, United Kingdom.; Department of Obstetrics and Gynaecology, University Hospital Helsinki, Helsinki University, 00290 Helsinki, Finland.
Bowden S; Department of Gut, Metabolism and Reproduction, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London SW7 2DD, United Kingdom.; Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London SW7 2DD, United Kingdom.; Department of Obstetrics and Gynaecology, Imperial College Healthcare NHS Trust, London W2 1NY, United Kingdom.
Lathouras K; Department of Obstetrics and Gynaecology, Imperial College Healthcare NHS Trust, London W2 1NY, United Kingdom.
Rosini F; Department of Gut, Metabolism and Reproduction, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London SW7 2DD, United Kingdom.; Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London SW7 2DD, United Kingdom.
Szasz M; Department of Tumour Biology, National Koranyi Institute of Pulmonology, 1122 Budapest, Hungary.
Savage A; Department of Gut, Metabolism and Reproduction, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London SW7 2DD, United Kingdom.; Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London SW7 2DD, United Kingdom.
Manoli E
Balog J; Department of Gut, Metabolism and Reproduction, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London SW7 2DD, United Kingdom.; Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London SW7 2DD, United Kingdom.; Waters Research Center, 1031 Budapest, Hungary.
McKenzie J; Department of Gut, Metabolism and Reproduction, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London SW7 2DD, United Kingdom.; Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London SW7 2DD, United Kingdom.
Lyons D; Department of Obstetrics and Gynaecology, Imperial College Healthcare NHS Trust, London W2 1NY, United Kingdom.
Bennett P; Department of Gut, Metabolism and Reproduction, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London SW7 2DD, United Kingdom.; Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London SW7 2DD, United Kingdom.; Department of Obstetrics and Gynaecology, Imperial College Healthcare NHS Trust, London W2 1NY, United Kingdom.
MacIntyre D; Department of Gut, Metabolism and Reproduction, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London SW7 2DD, United Kingdom.; Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London SW7 2DD, United Kingdom.
Ghaem-Maghami S; Department of Gut, Metabolism and Reproduction, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London SW7 2DD, United Kingdom.; Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London SW7 2DD, United Kingdom.; Department of Obstetrics and Gynaecology, Imperial College Healthcare NHS Trust, London W2 1NY, United Kingdom.
Takats Z; Department of Gut, Metabolism and Reproduction, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London SW7 2DD, United Kingdom; .; Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London SW7 2DD, United Kingdom.
Kyrgiou M; Department of Gut, Metabolism and Reproduction, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London SW7 2DD, United Kingdom; .; Department of Surgery and Cancer, Institute of Reproductive and Developmental Biology, Faculty of Medicine, Imperial College London, London SW7 2DD, United Kingdom.; Department of Obstetrics and Gynaecology, Imperial College Healthcare NHS Trust, London W2 1NY, United Kingdom.
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Źródło:
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Proceedings of the National Academy of Sciences of the United States of America [Proc Natl Acad Sci U S A] 2020 Mar 31; Vol. 117 (13), pp. 7338-7346. Date of Electronic Publication: 2020 Mar 16.
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Typ publikacji:
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Journal Article; Research Support, Non-U.S. Gov't
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Język:
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English
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Imprint Name(s):
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Original Publication: Washington, DC : National Academy of Sciences
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MeSH Terms:
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Mass Spectrometry/*instrumentation
Mass Spectrometry/*methods
Uterine Cervical Neoplasms/*pathology
Adult ; Aged ; Discriminant Analysis ; Female ; Gas Chromatography-Mass Spectrometry/instrumentation ; Gas Chromatography-Mass Spectrometry/methods ; Humans ; Margins of Excision ; Middle Aged ; Papillomaviridae ; Papillomavirus Infections/pathology ; Precancerous Conditions/diagnosis ; Precancerous Conditions/surgery ; Sensitivity and Specificity ; Uterine Cervical Neoplasms/diagnosis ; Uterine Cervical Neoplasms/surgery ; Uterine Cervical Dysplasia
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Grant Information:
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PS2857 United Kingdom MRC_ Medical Research Council; PS2897 United Kingdom MRC_ Medical Research Council; P83204 United Kingdom DH_ Department of Health; A24034 United Kingdom CRUK_ Cancer Research UK
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Contributed Indexing:
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Keywords: REIMS; cervical cancer; fertility preservation; iKnife; mass spectrometry
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Entry Date(s):
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Date Created: 20200318 Date Completed: 20200814 Latest Revision: 20221207
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Update Code:
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20240105
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PubMed Central ID:
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PMC7132269
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DOI:
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10.1073/pnas.1916960117
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PMID:
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32179675
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Clearance of surgical margins in cervical cancer prevents the need for adjuvant chemoradiation and allows fertility preservation. In this study, we determined the capacity of the rapid evaporative ionization mass spectrometry (REIMS), also known as intelligent knife (iKnife), to discriminate between healthy, preinvasive, and invasive cervical tissue. Cervical tissue samples were collected from women with healthy, human papilloma virus (HPV) ± cervical intraepithelial neoplasia (CIN), or cervical cancer. A handheld diathermy device generated surgical aerosol, which was transferred into a mass spectrometer for subsequent chemical analysis. Combination of principal component and linear discriminant analysis and least absolute shrinkage and selection operator was employed to study the spectral differences between groups. Significance of discriminatory m/z features was tested using univariate statistics and tandem MS performed to elucidate the structure of the significant peaks allowing separation of the two classes. We analyzed 87 samples (normal = 16, HPV ± CIN = 50, cancer = 21 patients). The iKnife discriminated with 100% accuracy normal (100%) vs. HPV ± CIN (100%) vs. cancer (100%) when compared to histology as the gold standard. When comparing normal vs. cancer samples, the accuracy was 100% with a sensitivity of 100% (95% CI 83.9 to 100) and specificity 100% (79.4 to 100). Univariate analysis revealed significant MS peaks in the cancer-to-normal separation belonging to various classes of complex lipids. The iKnife discriminates healthy from premalignant and invasive cervical lesions with high accuracy and can improve oncological outcomes and fertility preservation of women treated surgically for cervical cancer. Larger in vivo research cohorts are required to validate these findings.
Competing Interests: Competing interest statement: Waters Corporation provided supplies and maintenance for the mass spectrometry equipment used. Z.T. serves as a paid consultant for Waters Corporation. J.B. is employed by Waters Corporation.
(Copyright © 2020 the Author(s). Published by PNAS.)
Erratum in: Proc Natl Acad Sci U S A. 2020 Aug 4;117(31):18892. (PMID: 32747541)
