1. Lipidomic Profiling of Neoplastic, Pre-Neoplastic, and Healthy Tissues Using Electrocautery Paired with Mass Spectroscopic Equipment
Presenter:
Joseph M. Gosnell
Hepatocellular Carcinoma

2. Case Study
46 YO Male
Diagnosed with NAFLDNASH progression after presenting with hematemesis, esophageal varices, splenomegaly, and diffuse hepatic fibrosis
After three years, patient developed hepatocellular carcinoma (HCC), a solid liver tumor, manifesting in three distinct locations less than 3cm in diameter
It was decided that the patient would undergo a TIPS procedure to reduce hepatic portal vein hypertension, allowing for a chemoembolization of the HCC masses in the liver
Patient decompensated when the procedure formed a thrombus which traveled to a branch of the R marginal artery
Patient continued to decompensate, resulting in hepatorenal syndrome in December, and multiple organ failure in March/April of this year.
Patient died at 50 YO on April 6, 2015.

3. Resection of Hepatocellular Carcinoma Tumors
Two Surgical Approaches
Anatomical Resection
Lobectomy
Segmentectomy
Subsegmentectomy
Wedge Resection

4. Electrocautery
A small metal probe is electrified to either cut through tissue or cauterize (burn shut) blood vessels.
Also used to resect neoplastic tissues, i.e. tumors.

5. Mass Spectroscopy
Several methods used to identify tissue intra-operatively.
REIMS: Rapid Evaporative Ionization Mass Spectroscopy
TSI-MS: Tissue Spray Ionization Mass Spectroscopy

6. Phospholipids of Interest
Phospholipid: cell membrane components with lipids and phosphate groups
Differences in phospholipid content between neoplastic tissue and healthy tissue can indicate differences between tumors, pre-tumors, and healthy tissue.
PA PI PG
PE PS

7. Differences between Neoplasms and Healthy Tissue

8. Recent Pairing Efforts
Waters Corporation
iKnife System: pairs electrocautery with REIMS equipment for intraoperative identification of neoplastic, pre-neoplastic, and healthy tissue
Who will develop the next system with marketability?
Liberty University?

9. Applications: From Surgical Oncology to Food Testing
This technological pairing is applicable to more than surgery.
Research
Rapid analysis of phospholipids from organisms and tissue samples
Could reduce the amount of workflow necessary for analysis
Food Services and Verification
Can be used by FDA officials to test foods for pathogenic organisms
Can be used by restaurants and restauranteurs to determine meat quality (i.e. GrouperTilefish, Halibut, King Salmon, etc.)

10. References
Balog, J., Sasi-Szabo, L., Kinross, J., Lewis, M.R., Muirhead, L.J., Veselkov, K., Mirnezami, R., Dezso, B., Damjanovich, L., Darzi, A., Nicholson, J.K., and Takats, Z. (2013). Intraoperative tissue identification using rapid evaporative ionization mass spectrometry. Science Translational Medicine 5(194), p
Chau, G.Y. (2014). Resection of hepatitis-B virus-related hepatocellular carcinoma: Evolving strategies and emerging therapies to improve outcome. World Journal of Gastroenterology, 20(35), p
MedlinePlus. (2015). Electrocautery. neplus/ency/article/ htm
Waters Corporation. (2015). iKnife system. s/en_US/REIMS-Research- System-with-iKnife-Sampling- Device/nav.htm?cid= &locale=en_us
Waters Corp. iKnife. (2015). ch?v=Z9yVeMba0m0
Wei, Y., Chen, L., Zhou, W., Chingin, K., Ouyang, Y., Zhu, T., Wen, H., Ding, J., Xu, J., and Chen, H. (2015). Tissue spray ionization mass spectrometry for rapid recognition of human lung squamous cell carcinoma. Scientific Reports, 5, 10077; doi: /srep10077.

11. Picture Credits
Hepatic Lobectomy. rg/liver_tumor_center/treatme nts/surgery_remove_tumor.htm l
Grouper. assive-goliath-grouper- snatches-shark-single- bite/story?id=
Hepatic Segmentectomy. rg/liver_tumor_center/treatme nts/surgery_remove_tumor.htm l
Hepatic Wedge Resection. rg/liver_tumor_center/treatme nts/surgery_remove_tumor.htm l
Hepatocellular Carcinoma. m/category/hepatocellular- carcinoma/hepatocellular- carcinoma-hepatocellular- carcinoma
M. Gosnell. es/flint/obituary.aspx?pid=
Monopolar Cautery. m/medical_exhibits.php?exhibi t=13263_03X&query=monopola r%20cautery%20bipolar%20elec tric%20current%20electrode%2 0vaporization
Phosphatidic Acid. dex.php?option=com_content &view=article&id=389&Itemid= 259&catnumber=841188
Phosphatidylethanolamine. dex.php?option=com_content &view=article&id=389&Itemid= 259&catnumber=841188
Phosphatidylglycerol. dex.php?option=com_content &view=article&id=389&Itemid= 259&catnumber=841188
Phosphatidylinositol. dex.php?option=com_content &view=article&id=389&Itemid= 259&catnumber=841188
Phosphatidylserine. dex.php?option=com_content &view=article&id=389&Itemid= 259&catnumber=841188