Direct Mass Spectrometry Technologies for Intraoperative Tissue Analysis and Surgical Margin Evaluation

Surgical resection remains a primary treatment for solid tumors. However, achieving tumor-free margins during surgery is challenging. Residual cancer cells at surgical margins are associated with increased recurrence and reduced survival rates. Intraoperative evaluation of surgical margins could enable more complete resection and reduce positive margins. Traditional frozen section histopathology has limitations including time-consumption, sampling errors, and availability of expertise. Therefore, there is need for new rapid intraoperative technologies to analyze surgical margins. Direct analysis of tissue using mass spectrometry (MS) is emerging as a promising approach. MS can provide molecular profiles of surgical specimens within minutes. Different MS technologies have been applied for intraoperative tissue identification and classification, including Desorption Electrospray Ionization (DESI) MS¹, Rapid Evaporative Ionization (REIMS)², and MS Pen³. These tools show high accuracy for detecting cancerous tissues and defining surgical margins. Additional developments in MS technology, data analysis algorithms, and workflow could enable routine adoption of MS-guided surgery in the future. Ultimately, this has potential to improve surgical outcomes and reduce positive margins for cancer patients.

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