Surgical Spectroscopy

There isn’t much room for error in brain tumor surgery, but the difference between cancerous and healthy tissue is difficult to spot with the naked eye. What if laser Raman spectroscopy could warn surgeons as they’re approaching healthy tissue – before they even cut into it? That’s the premise behind a new trial of Canadian technology in the UK. Thomas Braun, CEO of Verisante, believes the technology could eventually be used akin to a parking sensor... “I envision our technology being used in a similar way in brain surgery in that there will be an audible beep as the surgeon closes in on healthy tissue.”

Verisante’s technology was originally developed for skin cancer over a period of 10 years by the University of British Columbia and the BC Cancer Agency in Canada. It works by identifying spectral changes associated with the biochemistry of cancer cells and applying a diagnostic algorithm, and was developed using clinical studies. A probe is pointed at suspicious lesions on the skin and a result of whether it is benign or cancerous is delivered in less than a second. The technology - Aura - is approved in Canada and the company is now seeking FDA approval.

“A lot of diagnostics just give you information, which the clinician then needs to interpret. Our technology tells you what you want to know,” says Braun. “The inventor originally targeted skin cancer because it was seen as an easier way to initially test the technology, but we’re also now developing it for use in the early detection of lung cancer via an endoscopic attachment. It’s very sensitive and we’ve used our patented technology to overcome a number of challenges, such as reducing the background noise from the signal.”

The technology caught the eye of neurosurgeon Babar Vaqas in the UK, who approached Verisante to ask if it could be adapted for use in brain tumor surgery, which led to a partnership between Verisante

and the Imperial College Healthcare NHS Trust. The study will focus on collecting raw data that can be examined after surgery to look for differences between normal and diseased brain tissue. And Braun expects to see a difference in the Raman spectra since the tissues are chemically different. Larger studies can then be performed to obtain enough data to develop an algorithm that can aid in determining brain tumor margins. Eventually, a commercial device will be on the cards. The study will also examine the feasibility of using the technology in an intraoperative environment in terms of convenience.

The technology shares objectives with the iKnife (see 'Our Phenome Future'), which will be entering clinical trials later in 2015. “I’m curious to hear more about the iKnife as the technology progresses,” says Braun, “The iKnife burns as it cuts and the smoke is analyzed by mass spectrometry – a key difference is that our technology is designed to identify cancerous tissue before a surgeon cuts into it.”

One thing is clear, surgeons are becoming increasingly vocal about the analytical tools they need. As Steven Olde Damink notes, “It is my belief that most real changes are driven by technological (and that is to say analytical) advances. The close collaboration between hardcore scientists all focusing on the development of new tools that help guide treatment and predict (and evaluate) treatment success [is] fascinating.”