Rapid evaporative ionization mass spectrometry in surgery: a systematic review

Background: Rapid evaporative ionization mass spectrometry (REIMS) is an emerging technology facilitating real-time intraoperative tissue identification during surgery. This review aims to discuss the applications and reported outcomes of REIMS technology in a surgical context. Methods: A systematic review was performed using four electronic databases that were searched in August 2025: MEDLINE, Emcare, Embase, and Web of Science. Eligible studies were peer-reviewed, included five or more patients, and evaluated REIMS technology in the context of a surgical specialty or pathology. Two independent reviewers screened studies, extracted data, and assessed risk of bias using the QUADAS-2 tool. The study protocol was registered in the PROSPERO international prospective register of systematic reviews before commencing the review (CRD42024546741). Results: A total of 344 records underwent initial screening, with 26 studies included. Included articles originated from seven countries and applied REIMS to eight surgical specialties. Twenty-three of the included articles used REIMS to identify cancerous tissue. All included studies reported both qualitative and quantitative outcomes. Included studies demonstrated a variety of surgical applications with promising results with regard to accuracy, sensitivity, and specificity. Both ex vivo and in vivo applications were explored, but limited in vivo data was reported and logistical limitations were identified. Conclusion: Most of the evidence supporting the use of REIMS in surgery originates from an ex vivo environment. Current limitations of the technique include equipment logistics and the complexity of interpretation of data and further in vivo studies with larger patient numbers are required to support more widespread application.