Brazil has become the second country in the world to evaluate a device that detects cancer in real-time during surgery. The MasSpec Pen system was developed by a research team that included Brazilian scientist Livia Eberlin, PhD, professor at Baylor College of Medicine, Houston, in partnership with Thermo Fisher Scientific.

The device is currently being assessed under a research protocol at Hospital Israelita Albert Einstein in São Paulo, Brazil.

Results from the US, where the technology is also under evaluation, showed an accuracy, sensitivity, and specificity above 96% in identifying breast, lung, thyroid, and ovarian tumors, according to a study published in Science Translational Medicine.

How the Device Works

When the Pen is in contact with the tissue, it releases a drop of water that absorbs cells from the site and maps their molecular signature through mass spectrometry, a technology that uses ionization to detect the molecular characteristics of each sample.

The data were recorded on a computer and compared with an artificial intelligence database that identifies whether the tissue contains cancer cells.

The entire process takes approximately 90 seconds, whereas a pathologist’s gold standard examination can take several minutes. The results were compared to validate the reliability of the device.

In addition to identifying tumors, the MasSpec Pen may help surgeons map the margins of neoplasms more precisely, reducing the need for additional operations to remove residual cancerous tissue. This precision can also reduce the risk for surgical complications.

Speaking with Medscape’s Portuguese edition, Kenneth J. Gollob, PhD, Head Translational Immuno-oncology Laboratory at Hospital Israelita Albert Einstein, said, “Sometimes you only discover later that a small margin of the tumor was left, and the surgeon may decide the best option is another operation. With the Pen, the goal is to minimize this type of procedure because the surgeon can identify exactly how far to resect the tissue. And it’s faster than the standard test.”

This speed, Gollob added, shortens the time a patient spends in the operating room and under anesthesia. This technology may also reduce discomfort for patients who remain awake during procedures and shorten the wait for test results.

In Brazil, the study is expected to last for 2 years and will include 60 patients: 30 with lung cancer and 30 with thyroid cancer. The selection followed three criteria: surgical accessibility, intraoperative diagnostic complexity, and maturity of the algorithm for tumor identification.

“The idea was to conduct the test far from where it was first developed because some technologies perform well locally but don’t replicate results when used elsewhere,” Gollob said.

Initial results are “very promising,” He added: The team is already considering expanding the analyses to include more patients and cancer types. “We hope to see strong statistical power in the comparisons. We’re excited to expand testing to other tumors,” he said.

Gustavo Gonçalves Silva, PhD, biologist from the Federal University of Ouro Preto, Ouro Preto, Brazil, and the São Paulo Research Foundation, serves as scientific liaison between research centers.

He spent 3 months in the US learning to operate the device and trained surgeons at Einstein. “There was strong collaboration among the hospital’s surgical, diagnostic, and research teams,” Gollob noted.

Exploring Prognostic Potential

Researchers at Einstein are also assessing a new application for technology: Determining whether the MasSpec Pen can identify immunological biomarkers of tumors.

“We want to see if the molecular profile obtained with the Pen reflects aspects of the tumor’s immune response. That’s important to determine whether the device can detect other molecular patterns associated with clinical outcomes, such as likelihood of response to therapy or risk for recurrence,” Gollob said.

If validated, the device could become an immediate prognostic tool, providing real-time information regarding the possible clinical course. Patients at a higher risk for recurrence could then receive more frequent follow-ups. However, validation remains in the initial stages, and no preliminary prognostic data are available.

This study compared the Pen’s molecular readings with laboratory approaches, such as DNA and RNA sequencing, which indicate immune activation. “We’ll compare the readings and see whether the Pen can detect patterns that correlate with immune responses. The advantage is that we would have immediate results, since immunologic and molecular analyses can take days or weeks,” Gollob said.

Future Potential

Expanding studies beyond the US strengthens the evidence, according to Gustavo Cardoso Guimarães, MD, director of the Institute of Uro-Oncology and Robotic Surgery, and general coordinator of oncologic surgical departments at Beneficência Portuguesa de São Paulo, São Paulo, Brazil.

Guimarães described the device as “an innovative and disruptive technology” that could potentially replace anatomical pathology analyses in the future. However, he emphasized that more studies are needed to assess the safety, risk, and cost.

“If high accuracy rates are confirmed at large scale and across tumor types, it could one day replace — or at least reduce — the need for anatomical pathology analyses,” he said. However, traditional tests remain essential, especially in uncertain cases, because they provide complete molecular information about the tumor, including its type and subtype.

According to Guimarães, the main benefits of the MasSpec Pen are precision and time savings. “As surgeons, our main goal is to remove the entire tumor with safe margins while reducing mutilation, side effects, and deformities,” he stated.

He cited thyroid cancer surgery as an example, noting that the dense nerve network in this area increases the risk for postoperative complications, such as hoarseness and calcium metabolism disorders.

Sarah Alves Moura is a journalist with 5 years of experience covering health and science. She has written for VivaBem (UOL), Época Negócios, and Band, and participated in Folha de S.Paulo’s science and health trainee program in 2022.

This story was translated from Medscape’s Portuguese edition.