'Smart' Knife May Identify Ovarian Cancer Tumor Tissue During Surgery

The practice of treating ovarian cancer largely through surgery is still an imperfect science.

A full clearance surgery that removes the uterus, cervix, fallopian tubes and ovaries is effective at removing all cancerous tissue, but also removes potentially healthy tissue — which is not ideal for younger women who are concerned about their future fertility.

In other cases, where only one ovary is removed, the surgery may not be radical enough. Cancerous cells could be left behind, prompting the need for further treatment or additional surgery.

However, a new tool that helps surgeons distinguish healthy tissue from tumor in real-time could change the landscape of surgical ovarian cancer treatment for the better.

Created by Zoltán Takáts, Ph.D., a professor of analytical chemistry at Imperial College London, the iKnife combines the scientific processes of surgery and mass spectrometry by weighing the molecules released in each puff of biologically-rich vapor, which is released during surgery, to identify what tissue the instrument is cutting in real time.

“With the iKnife we’re able to analyze the individual components that make up different tissues and tell them apart,” Takáts explained in a statement. “So, in surgery, you would know exactly what type of tissue you’re cutting through.”

Takáts and his colleagues recently published their research on this experimental device in the British Journal of Cancer, where they explained how the iKnife was tested in the lab.

After testing samples that were collected during surgery, the team compared the iKnife’s results with pathology reports and found that it was able to distinguish ovarian cancer from normal tissue with 100 percent accuracy. It was also able to identify various parts of the reproductive system 93 to 100 percent of the time.

Scientists have also begun to use the iKnife on borderline ovarian tumors, which are more common in younger women. The hope is to better identify these tumors for a more tailored treatment approach that will help preserve patients’ fertility.

In addition to testing more ovarian tumors, researchers will continue to add to the iKnife’s sample database to make the knife “smarter.”

As David Phelps, BM, DipHE, MRCOG, a Cancer Research UK-funded surgeon at Imperial College London and member of the team, noted their work will never be done. “I don’t think we’ll ever be finished adding to the dataset — the more data you put into it the more accurate it will become,” he said.

Beyond building their database, Sadaf Ghaem-Maghami, MBBS, Ph.D., MRCOG, consultant subspecialist in gynecological cancer surgery, reported that the team hopes to further test the knife so that it may be used during real-time surgery. “Based on the strength of the results, we’re looking to run a clinical trial to test if the iKnife can identify ovarian cancer in a surgical setting,” she said.

The team is also interested in testing the iKnife in other cancers. According to researchers, the potential implications of using the iKnife in brain surgery are huge. If possible, this tool would allow surgeons to remove the entire tumor without taking healthy brain tissue with it.

While there is still much more research to be done around the iKnife, the team is hopeful about what it could mean for the future of cancer surgery. “If the iKnife can give us an accurate diagnosis during the operation, it could completely change the surgical approach we choose,” Phelps said.