Clinical Report: Systematic Review of REIMS in Surgical Tissue Identification
Overview
Rapid evaporative ionization mass spectrometry (REIMS) is an emerging intraoperative technology that enables real-time tissue identification during surgery. This systematic review of 26 studies across multiple surgical specialties demonstrates promising accuracy, sensitivity, and specificity for REIMS, primarily in ex vivo settings, with limited but encouraging in vivo data.
Background
Intraoperative tissue identification traditionally relies on histopathology, which can be time-consuming and subject to interpretation variability. Techniques like frozen sections provide quicker preliminary diagnoses but still require 20–30 minutes and carry error risks. REIMS technology, coupled with electrosurgical diathermy (the 'intelligent knife' or iKnife), analyzes surgical smoke to generate mass spectrometric profiles for rapid tissue characterization. This approach aims to improve the speed, standardization, and accuracy of intraoperative tissue assessment.
Data Highlights
A total of 344 records were initially screened, with 26 studies meeting inclusion criteria. These studies originated from seven countries and covered eight surgical specialties. Twenty-three studies focused on cancerous tissue identification. Both qualitative and quantitative outcomes were reported, highlighting REIMS accuracy, sensitivity, and specificity. Most evidence derives from ex vivo applications, with limited in vivo data and noted logistical challenges.
Key Findings
REIMS demonstrated high diagnostic accuracy in identifying cancerous versus healthy tissue across multiple surgical specialties.
Most studies were conducted ex vivo, with limited but promising in vivo applications reported.
REIMS provides rapid tissue identification, potentially faster than traditional frozen section analysis.
Logistical challenges include equipment complexity and data interpretation requiring specialized expertise.
Risk of bias was assessed using QUADAS-2, with studies generally showing acceptable quality but heterogeneity precluding meta-analysis.
Further large-scale in vivo studies are needed to validate and expand REIMS clinical utility.
Clinical Implications
REIMS technology offers a promising tool for real-time intraoperative tissue identification, potentially improving surgical decision-making and patient outcomes by reducing reliance on slower histopathological methods. However, current limitations such as equipment logistics and data interpretation complexity must be addressed before widespread adoption. Clinicians should consider REIMS as an adjunct to existing intraoperative diagnostic modalities while awaiting further validation.
Conclusion
REIMS represents a novel, rapid, and accurate intraoperative tissue identification method with growing evidence supporting its use, particularly ex vivo. Future research should focus on overcoming logistical barriers and expanding in vivo applications to fully realize its clinical potential.
References
Systematic Review of Rapid Evaporative Ionization Mass Spectrometry Applications in Surgical Procedures, 2025
