New Study Could Improve Precision With Pituitary Tumor Excision

Physicians at the Brigham and Women’s Hospital (BWH) have published results from a proof-of-concept study that used mass spectrometry in almost real-time to detect and delineate pituitary tumors from normal tissue. This, the authors claim, can support critical surgical decisions and allow for more precise tumor excision.

Published in the Proceedings of the National Academy of Sciences, the authors used matrix-assisted laser desorption/ionization (MALDI) mass spectrometry imaging (MSI) to analyze 6 nonpathological human pituitary gland and 45 hormone secreting and nonsecreting human pituitary adenomas. Expression of several pituitary hormones such as prolactin, growth hormone, adrenocorticotropic hormone, and thyroid stimulating hormone were detected in the tumor as well as the normal pituitary gland. The authors confirmed that MALDI MSI could successfully detect excess hormone production in the tumor tissue and the analysis can be completed in less than 30 minutes—a big advantage for intraoperative surgical decision-making.

This would be a big step-up from current methods used to detect hormone levels that are time consuming and force excision of a larger amount of potentially healthy pituitary gland or even follow up surgery if the tumor has not been fully removed.

“Our work is driven by a clinical need: we've developed a test specifically tailored for the needs of our neurosurgeon colleagues,” said corresponding author Nathalie Agar, PhD, director of the Surgical Molecular Imaging Laboratory in the Department of Neurosurgery at BWH. "A surgeon may sacrifice half of the pituitary gland in an effort to get the tumor out. Without a tool to distinguish healthy tissue from tumor, it's hard to know in real-time if the surgery was a success.” The new technique can overcome this barrier.

Their study, the authors write, supports the inclusion of MALDI MSI in the clinical workflow for the surgical resection of pituitary tumors, potentially allowing for improved surgical precision and patient outcomes. Further studies will evaluate the impact of the technique on clinical decision making.