M. Keating3, C. Wolfe3, T. Hilton1, C. Tanguma1, P. Antaby1, K. Rangel1, S. Bowers1, C. Vicencio1, S. Westin1, J. Taylor1, A. Jazaeri1, P. Soliman1, B. Lawson2, J. Liu2, A. Sood1, L. Eberlin3, N. Fleming1 1University Of Texas MD Anderson Cancer Center, Department Of Gynecologic Oncology And Reproductive Medicine, Houston, TX, USA 2University Of Texas MD Anderson Cancer Center, Department Of Pathology, Division Of Pathology-Lab Medicine, Houston, TX, USA 3Baylor College Of Medicine, Division Of Surgical Oncology, Houston, TX, USA
Introduction: Primary treatment for patients with high grade serous ovarian carcinoma (HGSC) includes a combination of chemotherapy and surgery. Patients with HGSC experience better outcomes and long-term survival rates when complete resection can be achieved. Yet, accurate intraoperative identification of metastatic disease in vivo can be challenging, especially after neoadjuvant chemotherapy. Here, we report the deployment and testing of the MasSpec Pen technology integrated to a orbitrap Exploris mass spectrometer for in vivo and ex vivo molecular analysis and tissue diagnosis during human ovarian cancer surgeries in a rigorous clinical study.
Methods: Eligible patients with HGSC who received neoadjuvant chemotherapy and were scheduled for interval tumor reductive surgery (iTRS) were consented prior to their surgery. An Orbitrap Exploris 240 equipped with a MasSpec Pen source was placed on a cart and rolled into an operating room ~5 m away from the operating table. In vivo measurements were performed by surgeons and ex vivo measurements were made by research personnel. Analysis sites were marked with surgical ink for pathological analysis.
Results: We established a rigorous clinical study to translate the technology and test feasibility of the MasSpec Pen for real-time disease state assessment during ovarian cancer surgeries. Prior to analyses, sterilized MasSpec Pen devices were provided to the surgeon (in the sterile field) by the scrub nurse and connected to the Exploris 240 using 4.5m of PTFE tubing. Several tissue sites were analyzed intraoperatively at the discretion of the operating surgeon and depending on the presence of metastatic cancers including ovarian, uterus, peritoneum, mesentery bowel, and omentum tissues. In vivo measurements were performed by the operating surgeons. Immediately after performing 3 consecutive in vivo measurements, the site that was analyzed in vivo was marked with a surgical pen or stitched prior to excision. After the surgeon removed the analyzed tissue, the same site that was analyzed in vivo was analyzed ex vivo. Following ex vivo analysis, the evaluated site was marked with permanent ink to indicate to the pathology team where the MasSpec Pen was used for pathological evaluation of each analysis site.
Conclusion: Thus far, we have deployed the MasSpec Pen and collected intraoperative mass spectra of ovarian tissues in vivo and ex vivo during 16 ovarian cancer surgeries This is the first report of the MasSpec Pen for clinical use during ovarian cancer surgeries. We are currently assessing the correlation between mass spectra collected during surgery and final pathological assessment.