Enhanced diagnostic accuracy of SINE-EUS compared to standard EUS in early colorectal cancer: a self-controlled study.

Purpose: This study compared the diagnostic performance of standard endoscopic ultrasound (EUS) and submucosal injection of normal saline and epinephrine-enhanced EUS (SINE-EUS) in detecting early colorectal cancer (CRC), emphasizing accuracy, sensitivity, and specificity.

Methods: The self-controlled study was conducted with 115 patients diagnosed with early CRC through optical enhancement (OE) magnified endoscopy. Among them, 104 patients underwent sequential diagnostic procedures, starting with standard EUS and followed by SINE-EUS. Pathological findings were used as the reference standard. Statistical analyses assessed the diagnostic metrics and identified factors influencing accuracy.

Results: Among 104 patients, 82 were pathologically diagnosed with early CRC (63 cases of Tis/T1a and 19 cases of T1b). Standard EUS showed a sensitivity of 68.3%, specificity of 52.6%, and overall accuracy of 64.6%. In contrast, SINE-EUS significantly improved sensitivity (85.7%), specificity (68.4%), and overall accuracy (81.7%) (P < 0.0167). Risk factors such as ulceration were identified as independent predictors of reduced diagnostic accuracy.

Conclusions: SINE-EUS outperforms standard EUS in diagnosing early CRC, particularly in terms of sensitivity and overall accuracy. This technique is reliable for clinical application, although limitations remain in improving specificity for deeper lesions.