The Role of Intraoperative Flow Cytometry in Surgical Oncology: A Systematic Review

Purpose: The aim of this review is to evaluate the role of intraoperative flow cytometry (IFC) in tumor surgery. Methods: The Medline, Scopus, and Cochrane databases were searched up to 21 June 2025 to identify all available studies that met the inclusion criteria for final evaluation. To assess the risk of bias and applicability concerns, the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool was used. Results: A total of 22 studies involving 1511 patients with various tumor types were analyzed to assess the utility of IFC in the rapid diagnosis of tumors. The studies investigated IFC's role in tumor grading, margin delineation, prognostic evaluation, and in differentiating neoplastic from benign lesions, as well as normal from cancerous tissues. In brain tumors, particularly gliomas and meningiomas, IFC demonstrated high diagnostic performance, with reported sensitivities ranging from 61% to 100% and specificities from 66% to 100%. Studies on non-brain tumors also showed high accuracy in distinguishing neoplastic from normal tissues, with sensitivities and specificities exceeding 85% in most cases. The most promising results were observed in brain tumor surgery, although its application in other tumor types continues to expand. Conclusions: IFC appears to be a valuable intraoperative tool in surgical oncology, providing rapid results within minutes and assisting in surgical and therapeutic decision-making. Nonetheless, studies remain limited, and further research is needed, particularly for non-brain tumors, to establish standardized cut-off values and enhance diagnostic reliability.