An intelligent knife is found to detect a common cancer within seconds

The iKnife was already in use to treat breast and brain cancer, and the latest development is another leap forward.

The iKnife is based on electrosurgery

The inventor of this revolutionary instrument, Dr. Zoltan Takats of Imperial College London, connected an electrosurgical knife to a mass spectrometer years ago, to create the iKnife. A mass spectrometer can identify the chemicals present in a sample. As different types of cells can produce metabolites in various concentrations, the profile of chemicals in a sample can reveal a host of information about the tissue.

The iKnife is based on electrosurgery. Electrosurgical knives employ an electrical current to quickly heat tissue, "cutting through it while minimizing blood loss. In doing so, they vaporize the tissue, creating smoke that is normally sucked away by extraction systems," according to a release. 

According to the researchers, the effectiveness of the instrument was proved using biopsy tissue samples from 150 women who were suspected of womb cancer. The iKnife used electrical currents to distinguish between cancerous and healthy tissue by analyzing the smoke emitted when the biopsy tissue is vaporized, post-removal from the womb.

The results were then compared with current diagnosis methods. 

A step change in faster diagnosis

While the disease is the fourth most common cancer in women, only 10 percent of those with suspected symptoms who undergo a biopsy are found to have it, The Guardian reported.

"Womb cancer has one ‘red flag’ symptom of postmenopausal bleeding that should always get checked out on a two-week referral from your GP. To wait a further two weeks for the results can be really hard for patients," Athena Lamnisos, the chief executive of the Eve Appeal cancer charity, which funded the research, told The Guardian. 

"There are many reasons for abnormal vaginal bleeding after the menopause – womb cancer is just one of them – the ability to provide a diagnostic test that rules cancer in or out immediately, and with accuracy, could make such a positive difference," Lamnisos continued.

"This Eve-supported research has the potential to create a step change in faster diagnosis, and for the 90 percent of women with postmenopausal bleeding that isn’t cancer, a really effective way to put their minds at ease. We know how important this is for patients," Lamnisos added.

A major clinical trial could lead to widespread use

Professor Sadaf Ghaem-Maghami, who led the research at Imperial College London, told The Guardian that getting a diagnosis within seconds could help those confirmed with cancer to begin treatment as soon as possible. And those deemed healthy could avoid weeks of waiting and anxiety.

"With its high diagnostic accuracy of 89 percent and positive predictive value of 94 percent, one could immediately reassure the person of the very low likelihood of having cancer if the iKnife result is negative and expedite further tests and scans and treatment for people whose biopsies indicate the presence of cancer. This could happen whilst await confirmation from standard pathology, which can take up to two weeks," Ghaem-Maghami said.

The team plans to launch a major clinical trial next.

Study Abstract:

Delays in the diagnosis and treatment of endometrial cancer negatively impact patient survival. The aim of this study was to establish whether rapid evaporative ionisation mass spectrometry using the iKnife can accurately distinguish between normal and malignant endometrial biopsy tissue samples in real time, enabling point-of-care (POC) diagnoses. Methods: Pipelle biopsy samples were obtained from consecutive women needing biopsies for clinical reasons. A Waters G2-XS Xevo Q-Tof mass spectrometer was used in conjunction with a modified handheld diathermy (collectively called the ‘iKnife’). Each tissue sample was processed with diathermy, and the resultant surgical aerosol containing ionic lipid species was then analysed, producing spectra. Principal component analyses and linear discriminant analyses were performed to determine variance in spectral signatures. Leave-one-patient-out cross-validation was used to test the diagnostic accuracy. Results: One hundred and fifty patients provided Pipelle biopsy samples (85 normal, 59 malignant, 4 hyperplasia and 2 insufficient), yielding 453 spectra. The iKnife differentiated between normal and malignant endometrial tissues on the basis of differential phospholipid spectra. Cross-validation revealed a diagnostic accuracy of 89% with sensitivity, specificity, positive predictive value and negative predictive value of 85%, 93%, 94% and 85%, respectively. Conclusions: This study is the first to use the iKnife to identify cancer in endometrial Pipelle biopsy samples. These results are highly encouraging and suggest that the iKnife could be used in the clinic to provide a POC diagnosis.