Intraoperative narrow-band imaging effectively estimates tumor invasion depth in gallbladder cancer, crucial for surgical strategy.

• 66.7% of patients with suspected disease were diagnosed with gallbladder cancer.
• Intraoperative NBI had a diagnostic sensitivity of 79.5% for identifying ≥ T2 invasion, outperforming CT and EUS.

Surgeons can use NBI for real-time assessment of cancer depth and lymphatic involvement, enhancing intraoperative decision-making.

• Positive NBI findings were linked to significant microvascular changes and lymphatic invasion.