Real-Time Molecular Patterns to support Intraoperative Decision-Making

Metabolic profiling represents a new approach for rapid tissue diagnostics, with the potential to improve clinical decisions, especially during cancer surgery. Over the past years, driven by technological developments, the field of mass spectrometry imaging has established the link between histopathology and molecular patterns among diverse biomedical applications, especially in cancer research. The present study contributes to prove the reproducibility of a real-time metabolic profiling technology, rapid evaporative ionization mass spectrometry (REIMS), through a cross-continental multicentre study on breast cancer, with goal to support surgeons with tumour resection. The potential of REIMS to provide relevant tissue classification beyond the information provided by histopathology is established by using the molecular alterations surrounding breast tumours towards real-time guidance of breast-conserving surgery. Furthermore, real-time lipid patterns are used for precise tumour characterization with typing of primary and metastatic liver tumours. Finally, a common ceramide pattern characteristic of tumour necrosis is reported and targeted metabolic shifts in necrosis are suggested to provide new insights for tumour classifications in cancer precision medicine.