Hyperspectral imaging for tumor resection guidance in surgery: a systematic review of preclinical and clinical studies

Significance: Hyperspectral imaging (HSI) is a promising real-time, non-invasive, non-ionizing optical imaging technique. In surgical oncology, HSI can capture both structural and functional tissue information, allowing the characterization of tumor lesions both intraoperatively and on a histopathological level. Aim: We review the latest technological and clinical advancements of HSI as a guidance tool for tumor resection. Approach: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we systematically searched MEDLINE, Embase, and Web of Science using logical keyword combinations related to "hyperspectral imaging" and "surgical oncology." Eighty-five articles published between January 1, 2014, and April 30, 2024, were selected based on predefined inclusion and exclusion criteria. Technical and clinical data were extracted and analyzed. Results: The reviewed studies include preclinical and clinical investigations involving various tumor models and 2163 patients, including 24 pediatric cases. HSI has demonstrated broad applicability across various anatomical regions in both ex vivo and in vivo settings, with its most valuable application being tumor tissue delineation. Conclusions: HSI remains in its early technological stages, requiring high-quality evidence and multidisciplinary collaboration to support clinical adoption. A deeper understanding and improved characterization of biological tissue hyperspectral properties are essential to better inform and orient future hardware and software designs.