Will Ambient Ionization Mass Spectrometry Become an Integral Technology in the Operating Room of the Future?

摘要

Cancer surgeons face on a daily basis the difficult task of determining the delicate boundary between cancerous and normal tissue. Additionally, they must decide how much noncancerous margin of normal tissue to resect along with the tumor. Among the factors considered when deciding the extent of tissue resection are tumor type, location next to vital structures, morbidity of aggressive resection, tumor aggressiveness, adjunct chemotherapies available, survival rates and the patients' medical background. In the majority of cancer surgeries, the resected tissue samples are sent to a nearby room, often called the “frozen room,” for tissue processing and evaluation. The tissue is quickly frozen, sectioned, stained and interrogated using light microscopy by an expert pathologist who carefully evaluates if the surgical margins contain cancer cells (positive margin) or not (negative margin). This process of intraoperative surgical margin evaluation has been performed in clinical practice for decades, although it has many challenges. Freezing artifacts occur during tissue processing and interfere with tissue structure and cell morphology, thus complicating pathologic interpretation. Moreover, certain tumor cells are very difficult to recognize due to their atypical pattern of growth and shape. Often more than one pathologist is involved to make a final and difficult decision on margin status. Logistically, in most hospitals in the US, the frozen room serves several operating rooms (ORs),4 and depending on the workload, a surgeon may need to wait an undesirable amount of time (over 30 min) for a final reading before deciding whether to conclude or continue a surgery. This process results in prolonged length of surgery and associated increase in anesthesia time, increasing the risk of surgical site infection and physiologic stress to the patient.In brain cancer surgery, surgical margin evaluation is critical because sparing normal marginal tissue may significantly impact postoperative quality of life. New …