Incise the endometrium using a surgical tool called “iKnife” (for “intelligent scalpel”) and know, in less than two seconds, if the affected part contains cancerous cells. This is the promise of the innovative prototype tested by a team from Imperial College (London) and described in the publication Cancer of December 14, 2022.
The innovation is based on electrosurgery, a technology born a century ago: scissors cut electrically heated tissue to minimize bleeding. But British researchers have added a second brick to this device. The vapors emanating from this cut/burn are aspirated and chemically analyzed by a mass spectrometer.
“Women with abnormal bleeding are usually rushed to our clinics for examination. They often undergo a CT scan and an endometrial biopsy. The majority don’t have cancer, but they have to wait several days or even weeks before getting a diagnosis.”explains Professor Sadaf Ghaem-Maghami, lead author of the article and head of the department of gynecological oncology at Imperial College. “I had heard about this technology available at our university [le bistouri intelligent avait déjà été testé sur des tissus cancéreux du côlon, des poumons et du foie]. In 2019, I thought we could use it to make an immediate diagnosis of biopsies already done to see if this approach was accurate,” she remembers.
89% diagnostic accuracy
Tested on 150 endometrial biopsies – multi-used to give 453 spectrometric analyzes – the iKnife differentiated between healthy and malignant tissues with a diagnostic accuracy of 89%. The sensitivity of the tool (probability of being tested positive when one is sick) is 85% and its specificity (probability of being tested negative when one is not sick) of 93%.
“The next step is to conduct a large multicenter study [incluant plusieurs centres au même moment selon le même protocole ] in the UK and probably Europe to measure the performance of the device in clinics and see what impact it will have on care, projects Sadaf Ghaem-Maghami. If its usefulness is proven, it could be integrated in the long term into current clinical practice. »
For Professor Fabrice Lecuru, cancer surgeon at the Institut Curie, “the results of this prototype are still insufficient, but the approach is interesting”. If the diagnostic precision improves, the interest of this tool could be, during the ablation of a tumor for example, “to be able to adjust the surgical margin so as not to take too much healthy tissue and not to pass too close to the tumor”, in order to limit the risk of recurrence.