Identification of breast tumors from diathermy smoke by differential ion mobility spectrometry

Abstract

Introduction: Breast cancer is the most frequent cancer in women worldwide. The primary treatment is breast-conserving surgery or mastectomy with an adequate clearance margin. Diathermy blade is used extensively in breast-conserving surgery. Surgical smoke produced as a side product has cancerspecific molecular features. Differential mobility spectrometry (DMS) is a rapid and affordable technology for analysis of complex gas mixtures. In our study we examined surgical smoke from malignant and benign breast tissue created with a diathermy blade using DMS. Material and methods: Punch biopsies of 4 mm diameter from breast cancer surgical specimens were taken during gross dissection of fresh surgical specimen and placed in a well plate. The measurement system is a custom-built device called automatic tissue analysis system (ATAS) based on a DMS sensor. Each specimen was incised with a diathermy blade and the surgical smoke was analyzed. Results: We examined 106 carcinoma samples from 21 malignant breast tumors. Benign samples (n = 198) included macroscopically normal mammary gland (n = 82), adipose tissue (n = 88) and vascular tissue (n = 28). The classification accuracy when comparing malignant samples to all benign samples was 87%. The sensitivity was 80% and the specificity was 90%. The classification accuracy of carcinomas to ductal and lobular was 94%, 47%, respectively. Conclusions: Benign and malignant breast tissue can be identified with ATAS. These results lay foundation for intraoperative margin assessment with DMS from surgical smoke.

Recovery characteristics of different tube materials in relation to combustion products

“…1 a). A similar setup has been used in previous studies, where the aim was to identify tissue types by DMS measurements of surgical smoke ( [5,6,10]. The setup in the desorption and the measurement phase consisted only the individual 30 cm long sample tubes and the DMS device (Envi-AMC, Environics Ltd., Mikkeli, Finland).…”

“…Our team focuses on the development of methods for the analysis of surgical smoke that is produced in electrosurgery operation to classify the tissue types being operated ( [5,6]. The 95% of the mass of surgical smoke is water and the remainder consists of volatile organic compounds (VOCs) and cellular debris [7].…”

Smoke evacuation in endoscopic breast surgery can enhance operative visualization and respect surgical safety

“…The hazard of surgical smoke is a notoriously underestimated concept among surgical staff 1‐3 . Respirable ultrafine particulate matter generated from electrocauterization of human tissue has been reported to result in the presence of volatile hydrocarbons, carcinogens, bacteria, and viruses within the generated smoke 1‐5 . The concept of aerosolization of smoke, blood, and fluid has raised concerns for potential health problems including the dangers associated with chronic smoke inhalation, malignancy, and transmission of infectious diseases 1‐6 .…”

“…Respirable ultrafine particulate matter generated from electrocauterization of human tissue has been reported to result in the presence of volatile hydrocarbons, carcinogens, bacteria, and viruses within the generated smoke 1‐5 . The concept of aerosolization of smoke, blood, and fluid has raised concerns for potential health problems including the dangers associated with chronic smoke inhalation, malignancy, and transmission of infectious diseases 1‐6 . The importance of filtration systems, as opposed to wall suction, has been further exemplified during the COVID‐19 pandemic, whereby guidelines strongly recommended smoke evacuator devices with a formal closed suction and filtration systems to mitigate theoretical increased radius of transmission related to aerosolization 6…”

“…Low suction pressure can be utilized and titrated to preference in order to improve manual control. When commercial smoke evacuation systems are not available, consider connecting conventional suction tubing to the trocar or endoscope 5 . The main difference is that suction is continuously generated unless the team applies manual occlusion, as opposed to activate when required.…”