Code Blue

Intraoperative mass spec has been on the rise for some time  – from Zoltan Takats’ iKnife to Livia Eberlin’s MasSpec Pen. Yet technical issues as simple as power requirements are still limiting the full potential of mass spec in surgical rooms. 

In a May 2024 study, Michael Keating and the rest of Eberlin’s team – in collaboration with Orbitrap pioneer Alexander Makarov – have presented a solution to this challenge: running the MasSpec Pen with Orbitrap on just battery power. To assess feasibility, the scientists (literally) put wheels on their Orbitrap instruments (and yes, there is video proof in the paper) and rolled them through hospital corridors and moving elevators, while acquiring data. 

“‘But mass specs are not robust’.. ‘mass specs won't work in the OR’.. ‘they are too finicky’.. ‘I worked with MS in undergrad and it is too complex’.. statements I heard over years about MS are partially true BUT we are showing that MS can & will be adapted to work in hospitals!” tweeted Eberlin.

And there are more updates on the MasSpec Pen; it is now being adapted for identification of microbial cultures, minimal invasion screening of mouth cancer, ovarian carcinomas, and subtyping of non-small cell lung cancer – as presented at ASMS 2024 in Anaheim.

But has the MasSpec Pen been used in brain cancer? Not  according to a paper from Purdue University, Mayo Clinic, Tsinghua University, and Huashan Hospital. To that end, Mahdiyeh Shahi, Graham Cooks, and their colleagues introduce DESI-MS for the rapid detection of mutations in gliomas – in just a few minutes!

“Our measurements and prediction can be done in less than two minutes, which makes it ideal for an intraoperative diagnostic tool to be used during the surgery which could give more information to the surgeon about clear margins, so they can make better decisions on removing tumor tissue and when to stop removing it,” explained Shahi in a press release. 

In a 2023 interview, Cooks – who has been working on brain diagnostics using DESI-MS for the past 10 years – revealed that he’s surprised at how slowly this technology is being translated to point-of-care medicine. The reason? Both the cautious nature of the medical field when it comes to adopting new techniques and the dominance of -omics.

Nonetheless, Cooks argues that even though omics analysis data are valuable, they do not hold an operational value, as they’re only available after the surgery is complete. Both DESI-MS and the MasSpec Pen deliver real-time information to assist the clinicians with a diagnosis. 

From a technical perspective the tools are very promising, but perhaps these technologies are still too experimental in medical professionals’ eyes to use in practice. So, what will it take to overcome this hesitation? Most likely, collaboration. “Although the relationship between the mass spectrometry and medical communities is really close, one would hope to see many more joint publications between surgeons, pathologists, and experts in MS that address actual medical conditions and patient data,” says Cooks.

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