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“Intelligent knife” tells surgeon where the cancer is

July 18, 2013
Courtesy of University College London
and World Science staff

Sci­en­tists have re­portedly de­vel­oped an “in­tel­li­gent knife” that can tell sur­geons im­me­di­ately wheth­er the tis­sue they are cut­ting is can­cer­ous or not.

The “iKnife” di­ag­nosed tis­sue sam­ples from 91 pa­tients with per­fect ac­cu­ra­cy in an ope­rating-room study, in­stantly pro­vid­ing in­forma­t­ion that nor­mally takes up to half an hour to re­veal with lab tests, scien­tists said.

The find­ings, by re­search­ers at Impe­rial Col­lege Lon­don, were pub­lished July 17 in the jour­nal Sci­ence Trans­la­t­ional Med­i­cine.

In can­cers in­volv­ing sol­id tu­mors, re­mov­al of the can­cer in sur­gery is gen­er­ally the best hope for treat­ment. The sur­geon nor­mally takes out the tu­mor with a mar­gin of healthy tis­sue. But it’s of­ten im­pos­si­ble to tell by sight which tis­sue is can­cer­ous. One in five breast can­cer pa­tients who have sur­gery re­quire a sec­ond ope­ra­t­ion to fully re­move the can­cer. In cases of un­cer­tain­ty, the re­moved tis­sue is sent to a lab for ex­amina­t­ion while the pa­tient re­mains un­der gen­er­al an­es­thet­ic.

The iKnife is based on electrosur­gery, a tech­nol­o­gy in­vented in the 1920s that is com­monly used to­day. Elec­tro­sur­gery knives use an elec­tri­cal cur­rent to rap­idly heat tis­sue, cut­ting through it while min­i­miz­ing blood loss. In do­ing so, they va­por­ize the tis­sue, cre­at­ing smoke that is nor­mally sucked away by ex­trac­tion sys­tems.

The in­ven­tor of the iKnife, Zoltan Takats of Impe­rial Col­lege Lon­don, be­lieved this smoke would be a rich source of in­forma­t­ion. He con­nect­ed an elec­tro­sur­gery knife to a mass spec­trom­e­ter, an in­stru­ment used to iden­ti­fy what chem­i­cals are in a sam­ple. The pro­file of chem­i­cals in a bi­o­log­i­cal sam­ple can re­veal in­forma­t­ion about the state of that tis­sue.

The re­search­ers first used the iKnife to an­a­lyze tis­sue sam­ples col­lect­ed from 302 sur­gery pa­tients, re­cord­ing the char­ac­ter­is­tics of thou­sands of can­cer­ous and non-can­cer­ous tis­sues, in­clud­ing brain, lung, breast, stom­ach, co­lon and liv­er tu­mors to cre­ate a ref­er­ence li­brary. The iKnife works by match­ing its read­ings dur­ing sur­gery to the ref­er­ence li­brary to de­ter­mine what type of tis­sue is be­ing cut, giv­ing a re­sult in less than three sec­onds.

While the iKnife was be­ing tested, sur­geons were un­able to see the re­sults of its read­ings. The re­search­ers hope to car­ry out a clin­i­cal tri­al to see wheth­er giv­ing sur­geons ac­cess to the iKnife’s anal­y­sis can im­prove pa­tients’ out­comes.

“We be­lieve it has the po­ten­tial to re­duce tu­mor re­cur­rence rates and ena­ble more pa­tients to sur­vive,” Takats said. He added that the iKnife can iden­ti­fy many fea­tures be­sides can­cer, such as tis­sue with an in­ad­e­quate blood sup­ply, or types of bac­te­ria in the tis­sue. He has al­so done expe­ri­ments us­ing it to dis­tin­guish horse­meat from beef.


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Scientists have developed an “intelligent knife” that can tell surgeons immediately whether the tissue they are cutting is cancerous or not. The “iKnife” diagnosed tissue samples from 91 patients with 100 per cent accuracy in a study in the operating room, instantly providing information that normally takes up to half an hour to reveal using laboratory tests. The findings, by researchers at Imperial College London, are published today in the journal Science Translational Medicine. In cancers involving solid tumors, removal of the cancer in surgery is generally the best hope for treatment. The surgeon normally takes out the tumor with a margin of healthy tissue. However, it is often impossible to tell by sight which tissue is cancerous. One in five breast cancer patients who have surgery require a second operation to fully remove the cancer. In cases of uncertainty, the removed tissue is sent to a lab for examination while the patient remains under general anesthetic. The iKnife is based on electrosurgery, a technology invented in the 1920s that is commonly used today. Electrosurgical knives use an electrical current to rapidly heat tissue, cutting through it while minimizing blood loss. In doing so, they vaporize the tissue, creating smoke that is normally sucked away by extraction systems. The inventor of the iKnife, Zoltan Takats of Imperial College London, realized that this smoke would be a rich source of biological information. He connected an electrosurgical knife to a mass spectrometer, an instrument used to identify what chemicals are in a sample. The profile of chemicals in a biological sample can reveal information about the state of that tissue. The researchers first used the iKnife to analyze tissue samples collected from 302 surgery patients, recording the characteristics of thousands of cancerous and non-cancerous tissues, including brain, lung, breast, stomach, colon and liver tumors to create a reference library. The iKnife works by matching its readings during surgery to the reference library to determine what type of tissue is being cut, giving a result in less than three seconds. While the iKnife was being tested, surgeons were unable to see the results of its readings. The researchers hope to carry out a clinical trial to see whether giving surgeons access to the iKnife’s analysis can improve patients’ outcomes. “We believe it has the potential to reduce tumor recurrence rates and enable more patients to survive,” Takats said. He added that the iKnife can identify many features besides cancer, such as tissue with an inadequate blood supply, or types of bacteria in the tissue. He has also done experiments using it to distinguish horsemeat from beef.