New handheld device accurately identifies cancer in seconds during surgery
Dr. James Suliburk, Dr. Wendong Yu and Dr. Chandandeep Nagi.

A new handheld device rapidly and accurately identifies cancerous tissue during surgery, delivering results in about 10 seconds – more than 150 times as fast as existing technology. As reported in Science Translational Medicine, the MasSpec Pen is an innovative instrument that gives surgeons precise diagnostic information about what tissue to cut or preserve as they are performing surgery, helping to improve treatment and reduce the chances of cancer recurrence.

“Any time we can offer the patient a more precise surgery, a quicker surgery or a safer surgery, that’s something we want to do,” says Dr. James Suliburk, head of endocrine surgery at Baylor College of Medicine, associate professor of surgery and a collaborator on the project. “This technology does all three. It allows us to be much more precise in what tissue we remove and what we leave behind.”

“If you talk to cancer patients after surgery, one of the first things many will say is ‘I hope the surgeon got all the cancer out,’” says Dr. Livia Schiavinato Eberlin, assistant professor of chemistry at The University of Texas at Austin who designed the study and led the team of scientists, surgeons and engineers at UT Austin, Baylor College of Medicine and UT Texas MD Anderson Cancer Center. “It’s just heartbreaking when that’s not the case. But our technology could vastly improve the odds that surgeons really do remove every last trace of cancer during surgery.”

Suliburk collaborated with the team by procuring tissues for testing as well as in the development of the technology application for use in thyroid tumor samples. He also contributed toward a design of the instrument that was efficient and comfortable to use by surgeons during operations.

Assistant professor Dr. Wendong Yu and associate professor Dr. Chandandeep Nagi, both of pathology and immunology at Baylor College of Medicine, carried out pathologic evaluations of the tissue samples.

The current state-of-the-art method for diagnosing cancer and determining the boundary between cancer and normal tissue during surgery, called Frozen Section Analysis, is slow and sometimes inaccurate. Each sample can take 30 minutes or more to prepare and interpret by a pathologist, which increases the risk to the patient of infection and negative effects of anesthesia. And for some types of cancers, frozen section interpretation can be difficult, yielding unreliable results in as many as 10 to 20 percent of cases.

However, in tests on tissues removed from 253 human cancer patients, the MasSpec Pen took about 10 seconds to provide a diagnosis and was more than 96 percent accurate. The team has also demonstrated that the MasSpec Pen accurately diagnoses cancer in live, tumor-bearing mice during surgery without causing any observable tissue harm or stress to the animals. The team expects to start testing this new technology during oncologic surgeries in 2018.

Surgeons can operate the disposable handheld device easily. They would simply hold the pen against the patient’s tissue, triggering the automated analysis using a foot pedal, and waiting a few seconds for a result. Meanwhile, the pen releases a drop of water onto the tissue, and small molecules from the tissue migrate into the water. Then the device drives the water sample into an instrument called a mass spectrometer, which detects thousands of molecules as a molecular fingerprint. Cancerous tissues and normal tissues have distinct sets of molecules that can distinguish both types of tissue. When the MasSpec Pen completes the analysis, the words “Normal” or “Cancer” automatically appear on a computer screen.

Other contributors include Jialing Zhang, John Rector, John Q. Lin, Jonathan H. Young, Marta Sans, Nitesh Katta, Noah Giese, Alena Bensussan, Rachel J. DeHoog, Kyana Y. Garza, Benjamin Ludolph, Anna G. Sorace, Anum Syed, Aydin Zahedivash and Thomas Milner, all at UT Austin. Jinsong Liu is at The University of Texas MD Anderson Cancer Center.

This work was supported by the National Cancer Institute of the National Institutes of Health award 00CA190783, startup funds provided by The University of Texas at Austin and the Cancer Prevention Research Institute of Texas grants CPRIT RR160005 and CPRIT DP 150102.

Watch a video showing how the MasSpec Pen works.