The intelligent knife: new approach to cancer surgery

Scientists have developed an 'intelligent knife' that can tell surgeons immediately whether the tissue they are cutting is cancerous or not. An international team speculated that the metabolic status of tissue, as assessed by mass spectrometry, might aid in this process.

A handheld diathermy device was applied to tissue from the cervix to create a small "surgical aerosol" of compounds that was transferred through a suction tube to a mass spectrometer and analysed immediately. Evaluated tissue samples included 16 healthy cervical specimens, 50 human papillomavirus (HPV)–positive specimens (with or without cervical intraepithelial neoplasia), and 21 cervical cancer specimens. The mass spectrometry patterns (particularly lipid metabolite analysis) distinguished the three types of tissue with 100% sensitivity and specificity.

The authors envision a future where a diathermy wand with a tube sucks aerosolised tissue into a mass spectrometer in the operating room and identifies tissue that should be biopsied or resected, in real time. To reach that goal, this technique first will have to be tested on many more samples to confirm its accuracy and to determine the circumstances in which it is most useful. Finally, it remains to be seen if this technology can aid in identifying other precancerous lesions and other types of cancer, beyond cervical cancer.