The iKnife Can Tell The Difference Between Cancer And Healthy Tissue–Even When Doctors Can’t
It’s a bit scary to think about, but surgeons use electric knives that heat and break tissue apart to make cuts during surgery. This electrical cutting produces a small amount of smoke, and while it sounds gruesome, this method is actually quite clean and limits blood loss.
And the smoke it produces, doctors have discovered, could give surgeons important information about what kind of tissue they’re cutting and, more importantly, how much of it to cut.
During surgery, surgeons can’t always tell if they’re cutting part of a tumor or healthy tissue. In the case of cancer patients, it’s important that all the cancerous tissue be removed to avoid a second surgery, but at the same time doctors don’t want to cut away any more of the healthy tissue than is absolutely necessary.
Dr. David Phelps, a cancer research surgeon, explains the risk of cutting away too much: “At the moment, we take women into theatre [surgery] who have suspicious ovarian or pelvic masses and we do a full clearance surgery, removing the uterus and cervix, both ovaries and fallopian tubes. Two weeks later we get the pathology report back and find out the mass isn’t cancer in some cases, so we’ve been too radical with the surgery.”
It would be devastating for a woman to lose her reproductive organs, ending her chance of having children naturally, only to find that she never actually had cancer. However, that doesn’t mean that surgeons should risk being less aggressive. Not removing enough can mean enduring the risks and and expense of a second surgery if a post-surgery biopsy reveals that a patient still has cancer.
Dr. Daniel Leff, a breast cancer surgeon at Imperial College London, says that the women with breast cancer he operates on have to sign a consent form saying that they understand that about 20 to 30 percent of women will have to have a second operation if the first fails to remove 100 percent of their cancer.
But the iKnife can tell doctors if they’re cutting healthy or cancerous tissue in real time—it can even distinguish between different types of cancer. To work, the iKnife collects some of the smoke produced by the electrical cutting, and that smoke is fed into a molecular weight scale, also known as a mass spectrometer. The mass spectrometer analyzes the smoke and is able to tell the difference between different types of tissue.
Knowing what type of tissue is being cut instantly, instead of waiting for a biopsy, could mean a world of difference for doctors and patients. “We’ve shown that we can diagnose ovarian cancer in the lab using the iKnife, distinguishing it from normal tissue with 100% accuracy. It’s a hugely exciting result,” Dr. Phelps said.
The iKnife could have added benefits for women concerned about preserving fertility. The device can identify different parts of the reproductive system and tell the difference between ovarian cancer and a borderline ovarian tumor, though doctors are still working on increasing the number of samples tests so that the device can increase its accuracy (currently between 93 and 100 percent).
“The iKnife could help us to tailor our approach so we preserve fertility wherever possible,” said Dr. Sadaf Ghaem-Maghami, a consultant sub-specialist in gynecological cancer surgery.
Currently the iKnife is being testing in breast cancer trials. As of the time of this writing (August 2018) the knife has been used in over 500 surgeries, most of them for breast and colon cancers, but further testing is needed before widespread use.
If trials continue to be successful, the iKnife could revolutionize how doctors operate by allowing them to remove cancer with razor-sharp accuracy, reducing the number of second surgeries and allowing patients to preserve has much healthy tissue as possible.
For breast cancer patients, reducing the risk of additional surgeries, and keeping as much of their own bodies in tact as possible, could make a world of difference.