Podium Presentation in Room 4 on Wednesday at 9:20 (Chair: Peggi Angel / Anna Krieger)
Authors: Kyana Y. Garza (1), Jialing Zhang (1), Marta Sans (1), Rachel J. DeHoog (1), Mary King (1), Clara L. Feider (1), Alena Bensussan(1), John Q. Lin (1), Stacey A. Carter (2), Alastair Thompson (2), Elizabeth Bonefas (2), Chandandeep Nagi (2), James Suliburk (2), Chris Pirko (2), Kirtan Brahmbhatt (2), Livia S. Eberlin (1)
INTRODUCTION: Complete tumor removal during breast cancer surgery remains a challenge due to difficulties in precisely identifying disease at the specimen margins. Margin status of resected tissue is often evaluated postoperatively as there are limited clinical technologies that allow rapid and accurate intraoperative tissue assessment. As such, ~30% of breast cancer patients undergo multiple surgeries to achieve cancer free margins. We have developed the MasSpec Pen technology for rapid and non-destructive ex vivo and in vivo tissue analysis and diagnosis. We have used the MasSpec Pen and statistical classifiers to discriminate molecular patterns of normal and cancerous breast tissue and have achieved accuracies over 90% across multiple sample sets. We are currently evaluating feasibility of the MasSpec Pen for intraoperative analysis of breast tissues. Our results show the MasSpec Pen technology may be a powerful tool to provide surgical guidance during breast cancer surgery.
METHODS: Ex vivo experiments were performed using 143 banked human tissues including 79 normal and 64 breast cancer tissues. Samples were thawed and analyzed on various days using a mass spectrometer coupled to the MasSpec Pen. Analyzed regions of tissue were marked with a surgical marker, frozen, and sectioned at 5µm. Tissue sections were H&E stained for pathological evaluation. The molecular information acquired was used to build, test and validate classification models using the Lasso method.
RESULTS: To develop the method and build statistical classifiers, we first used the MasSpec Pen to analyze 79 normal and 64 breast cancer tissues ex vivo in our laboratory. Various metabolites, fatty acids, and lipids involved in cell metabolism were observed in the mass spectra. The model built yielded accuracies over 90% for the training (n=68), validation (n=22), and independent test set of samples (n=53).
Under IRB approval, we installed a MasSpec Pen system in an OR at the Texas Medical Center to test feasibility for analysis of tissue in vivo and freshly excised tissues. To date, we have performed MasSpec Pen analysis on tissues from 20 consented patients undergoing lumpectomies or mastectomies, with no complications reported. Similar to lab data, rich molecular profiles were obtained from breast tissues analyzed in vivo and on excised specimens. For one case, the MasSpec Pen was used to analyze the lateral and superior tumor margins. Predictive diagnoses of healthy breast were obtained for both margins, indicating negative status had been achieved, which corroborated with final pathological assessment. Continuous effort is focused on increasing patient accrual and continuing testing and refinement of the technology and statistical classifiers.
CONCLUSION: Our results demonstrate the ability of the MasSpec Pen to discriminate healthy from breast cancer tissue and showcase its potential as intraoperative tool for rapid breast tissue diagnosis and surgical margin assessment.
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