MSACL 2024 Abstract

Doctor "Did you get it all and am I going to be OK?" is the most common question asked of the surgeon after cancer resection surgery. It is the goal of the surgeon to resect all cancer tissue and cancer cells in the region of the tumor to provide the patient with the greatest probability for cure and to do so with the excision of the least amount of normal tissue to provide the patient with the best opportunity to return to normal function. For the 1 in 8 women who during their lifetime will experience Breast Cancer 20% of them will be disappointed as they will find out 1 to 2 weeks after the surgery after extensive review of the surgical specimen by a Pathologist there was tumor at the resection margin. No surgeon leaves the operating room believing he or she didn’t get it all, and they too are deeply disappointed by the result. Getting all the tumor means removing not only the tumor mass as is visualized by advanced imaging (US and MRI) and/or by palpation if possible; but also removing the microscopic tumor extensions and DCIS which cannot be felt, but that are also not visualized by imaging. Today we will introduce you to the concept of 3D Metabolic Image Guided Surgery and its use in breast cancer surgical resections and how it may be a valuable method to safely “get it all”. Our system is comprised of a 3D navigated cautery coupled with rapid evaporative ionization mass spectrometry (REIMS aka. I-knife). It also contains an imaging system that can display relative abundance of ions-of-interest or multivariate tissue classifications, relative to the location of the tumor mapped by US. We retrospectively assessed intraoperative margins by navigated REIMS in a series of 27 breast cancer surgery cases, and reveal a sensitivity of 100% and a specificity of 91% in comparison to ‘gold standard’ histopathology. Our results point to the utility of the system at indicating the presence, and 3D location of DCIS, as well as abnormal tissue at close margins. We demonstrate the feasibility of 3D metabolic image guided surgery at identifying cancer- containing margins intraoperatively. Using innovative imaging approaches, we are developing a user interface that can translate mass spectrometry data into clinically-meaningful guidance that is anticipated to help surgeons reduce the occurrence of positive margins in the future.