**Conflict of interest**

*Mass Spectrometry in Life Sciences and Clinical Laboratory*

model and to allow for using both modes during the surgery.

cancer, the normal tissue, and samples affected by HPV.

compounds such as proteins and ribosomal RNA.

and in surgical operating rooms.

about further procedure. St. John et al. described the use of iKnife for the identification of breast pathology for breast cancer surgery [159]. The aerosol produced by the monopolar hand piece used in surgery was aspirated and analytes therein were ionized in the mass spectrometer's ion source. Generated data were used to identify the tissue by applying multivariate analysis. The method proved to be able to identify the substances within a very short time range of 1.8 seconds. Here, the spectral differences that arise between the two operational modes of the electrosurgical knife – the "cut" and the "clog" – were combined to create a multivariate statistical

A further application where the iKnife was applied is ex-vivo use for diagnosis of cervical disease. The specimen obtained by cervical punch biopsy can either bee snap frozen and used for confirmation of the conventional histology analysis or it can be analyzed immediately upon sampling. Tzafetas et al. [158] was showed that the application of this technology enabled identification of lipids that characterize

MALDI mass spectrometry has already proved efficient for analyzing microorganism and for the offline imaging (MSI) tissue analyses. It is the MSI that represent an encouraging tool to support histopathology analyses and the decisionmaking processes. MALDI MSI captures the entire spectrum of biomolecules, including specific biomarkers, providing enhanced discriminating power over the visual inspection of tissue and placing it as a proper assisting method in diagnosis

With the progress of ambient mass spectrometry techniques, such DESI, MS became a powerful methodology for characterizing lipids within tumor specimens. The DESI MS analysis can be performed with minimal sample preparation and it provides molecular information from tissue samples rapidly. This qualifies the DESI and MALDI methods as a diagnostic method in the OP room. In addition to tumor classification, defining tumor subtypes, and identifying tumor grade, this method also provides necrotic tumor tissue identification, an indicator of highgrade malignancy, and can help distinguish necrotic tumor tissue from viable tumor

The use of MS in clinical laboratories worldwide increasing, and, as a result, substantial improvements in assay performance are occurring rapidly in many areas such as toxicology, endocrinology, and biochemical genetics. Numerous types of mass spectrometers are being used for the characterization of small molecules such as drugs of abuse, steroids, amines, amino and organic acids, as well as larger

The development of MS technologies has pushed clinical MS toward the analysis

of peptides and proteins for diagnostic examination. However, the quantitative analysis of proteins by MS is still a challenging area of laboratory medicine, which faces many challenges before being fit for a routine application. Also, MS contributes to the quality of the many test results (standardization of assays for steroids, lipids, hemoglobin A1c, etc.), and is used as a standard method in all US states for newborn screening. Furthermore, it is important to address that nearly every institution sends tests to the reference laboratories which frequently perform these tests using MS. With the improved functionality that benefits novel front-end modifications and computational abilities, MS can now be used for nontraditional clinical analyses, including clinical microbiology applications for bacteria differentiation

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procedure.

regions [159–162].

**3. Conclusion**

The authors declare no conflict of interest.
