Rapid evaporative ionization mass spectrometry in surgery: a systematic review
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By
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Angus R J Barber
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Alexander Dottore
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James Leigh
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Mark Fear
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Fiona Wood
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November 12, 2025
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Clinical Scorecard: Systematic Review of Rapid Evaporative Ionization Mass Spectrometry Applications in Surgical Procedures
At a Glance
| Category | Detail |
|---|
| Condition | Intraoperative tissue identification during surgery |
| Key Mechanisms | Diathermy-generated surgical smoke analyzed by mass spectrometry to identify tissue molecular profiles in real-time |
| Target Population | Patients undergoing surgical procedures requiring tissue identification, especially cancerous tissue |
| Care Setting | Intraoperative surgical environment |
Key Highlights
- REIMS technology enables rapid, real-time intraoperative tissue identification with promising accuracy, sensitivity, and specificity.
- Most evidence supporting REIMS use originates from ex vivo studies; limited in vivo data and logistical challenges remain.
- Coupling electrosurgical diathermy with REIMS (iKnife) allows molecular profiling of tissue vapor for immediate surgical decision-making.
Guideline-Based Recommendations
Diagnosis
- Use REIMS as a rapid intraoperative adjunct for tissue identification to complement histopathology.
- Recognize that REIMS can differentiate cancerous from non-cancerous tissue based on molecular ion profiles.
Management
- Incorporate REIMS technology to potentially reduce reliance on slower frozen section analysis during surgery.
- Consider logistical and interpretative complexities when implementing REIMS in clinical practice.
Monitoring & Follow-up
- Monitor diagnostic accuracy and sensitivity of REIMS intraoperatively to guide surgical margins and tissue resection.
- Further in vivo studies with larger patient cohorts are needed to validate monitoring protocols.
Risks
- Be aware of limitations including equipment logistics and complexity of data interpretation.
- Understand that current evidence is limited mostly to ex vivo applications; in vivo risks and limitations require further study.
Patient & Prescribing Data
Patients undergoing surgery for various pathologies, predominantly cancerous lesions
REIMS provides rapid tissue characterization intraoperatively, potentially improving surgical decision-making and outcomes; however, widespread clinical adoption awaits further validation.
Clinical Best Practices
- Employ REIMS technology as an adjunct to standard intraoperative diagnostic methods to enhance tissue identification speed and accuracy.
- Ensure multidisciplinary collaboration including surgical teams and pathology experts for interpretation of REIMS data.
- Prioritize further research and larger in vivo studies to establish standardized protocols and overcome current logistical challenges.
References
