Li Lingzhi, He Jiaming, Hu Haiyan, Wang Yingying, Li Weixin, Huang Shaohui, Rownoak Jahan, Xu Shenglin, Xie Fang, Wang Junfen, Mi Wenting, Cai Jianqun, Ye Yaping, Liu Side, Wang Jing, Li Yue
Department of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Economics of Global Health and Infectious Diseases Unit, Melbourne Health Economics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia.
Am J Gastroenterol. 2025 Mar 1;120(3):562-569. doi: 10.14309/ajg.0000000000002975. Epub 2024 Jul 25.
Linear-array endoscopic ultrasound (EUS) and narrow-band imaging (NBI) are both used to estimate the invasion depth of nonpedunculated rectal lesions (NPRLs). However, it is unclear which procedure is more accurate. This randomized controlled trial aimed to compare the diagnostic accuracy of linear EUS and NBI for estimating the invasion depth of NPRLs.
This study is a single-center, randomized, tandem trial. Eligible patients with NPRLs were randomly assigned to A group (assessment with EUS followed by NBI) or B group (assessment with NBI followed by EUS). The invasion depth of each lesion was independently measured by each procedure and categorized as mucosal to slight submucosal (M-SM s , invasion depth <1,000 μm) or deep submucosal (SM d , invasion depth ≥1,000 μm) invasion, with postoperative pathology as the standard of measurement. The primary outcome was diagnostic accuracy, and secondary outcomes included sensitivity, specificity, and procedure time.
Eighty-six patients with NPRLs were enrolled, and 79 patients were finally analyzed, including 39 cases in the A group and 40 cases in the B group. Comparable diagnostic accuracies were observed between EUS and NBI (96.2% vs 93.7%, P = 0.625). EUS identified lesions with deep submucosal invasion with 81.8% sensitivity while that of NBI was 63.6% ( P = 0.500). The specificity of both EUS and NBI was 98.5%. The procedure time was also similar between EUS and NBI (5.90 ± 3.44 vs 6.4 ± 3.94 minutes, P = 0.450). Furthermore, the combined use of EUS and NBI did not improve diagnostic accuracy compared with EUS or NBI alone (94.9% vs 96.2% vs 93.7%, P = 0.333).
Linear EUS and NBI measure the invasion depth of NPRLs with comparable accuracy. The combination of the 2 methods does not improve the diagnostic accuracy. Single NBI should be preferred, considering its simplicity and convenience in clinical practice.
线阵内镜超声（EUS）和窄带成像（NBI）均用于评估无蒂直肠病变（NPRL）的浸润深度。然而，尚不清楚哪种方法更准确。本随机对照试验旨在比较线阵EUS和NBI在评估NPRL浸润深度方面的诊断准确性。
本研究为单中心、随机、串联试验。符合条件的NPRL患者被随机分配至A组（先进行EUS评估，然后进行NBI评估）或B组（先进行NBI评估，然后进行EUS评估）。每种方法独立测量每个病变的浸润深度，并根据术后病理测量标准将其分类为黏膜至轻度黏膜下（M-SM s ，浸润深度<1000μm）或深层黏膜下（SM d ，浸润深度≥1000μm）浸润。主要结局为诊断准确性，次要结局包括敏感性、特异性和操作时间。
纳入86例NPRL患者，最终分析79例患者，其中A组39例，B组40例。EUS和NBI的诊断准确性相当（96.2%对93.7%，P = 0.625）。EUS识别深层黏膜下浸润病变的敏感性为81.8%，而NBI为63.6%（P = 0.500）。EUS和NBI的特异性均为98.5%。EUS和NBI的操作时间也相似（5.90±3.44对6.4±3.94分钟，P = 0.450）。此外，与单独使用EUS或NBI相比，联合使用EUS和NBI并未提高诊断准确性（94.9%对96.2%对93.7%，P = 0.333）。
线阵EUS和NBI在测量NPRL浸润深度方面准确性相当。两种方法联合使用并未提高诊断准确性。考虑到其在临床实践中的简单性和便利性，应首选单独的NBI。
