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Cross-sectional analysis enrolled 130 patients with SMEGC or GHGIN undergoing endoscopic submucosal dissection (ESD) at Nanjing Drum Tower Hospital. Lesion main/minor status was assessed using size, location, endoscopic morphology, histopathology, invasion depth, and vascular invasion. 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\n[https://doi.org/10.1007/s00432-025-06259-x](https://doi.org/10.1007/s00432-025-06259-x)  \nRESEARCH  \nAnalysis of clinicopathologic characteristics and risk factors for missed diagnosis in synchronous multiple early gastric cancer  \nZhao Shi1,2 · Song Zhang2,3 · Meng Wang4 · Huimin Guo1,2 · Lei Wang1,2 · Ying Lv1,2 · Xiaoping Zou1,2  \nReceived: 27 April 2025 / Accepted: 23 June 2025 © The Author(s) 2025  \nAbstract  \nAims This study aimed to enhance synchronous multiple early gastric cancer (SMEGC) detection by analyzing clinicopathological features, correlations between main/minor lesions in SMEGC and gastric high-grade intraepithelial neoplasia (GHGIN), and identifying risk factors for missed diagnoses.  \nMethod A cross-sectional analysis included 130 patients with SMEGC or GHGIN undergoing endoscopic submucosal dissection (ESD) at Nanjing Drum Tower Hospital. Clinicopathological characteristics were evaluated, with lesions classified as main or minor. Correlations between lesions were assessed based on size, location, endoscopic morphology, histopathology, invasion depth, and vascular invasion. Risk factors for missed diagnoses were analyzed.  \nResults Of 2580 patients treated with ESD, 130 with SMEGC or GHGIN were included in this study. The sizes ofthe main and minor lesions were positively correlated (r =0.658, p\u003C 0.001) . The main and minor lesions showed moderate consistency in pathological type (kappa =0.421, p\u003C 0.001) and low consistency in endoscopic morphology, depth of invasion, and longitudinal position (kappa \u003C 0.4, p\u003C 0.05). Of 130 included patients, diagnoses for 37 were missed. Small and non-primary lesions were independent risk factors for missed lesions. We also found that the hospital grade at first gastroscopy was a risk factor for missed diagnosis.  \nConclusions Endoscopists should be aware of the risk factors associated with SMEGC and consider the correlation between the main and minor lesions to prevent the oversight and misdiagnosis of SMEGC.  \nKeywords SMEGC · HGIN · Main and minor lesions · Clinicopathologic characteristics · Missed diagnosis  \nIntroduction  \nEarly gastric cancer (EGC) refers to gastric cancer that is confined to the mucosa or submucosa, regardless of the presence of regional lymph node metastasis (Kajitani 1981; Sano et al. 1992). According to the Japanese guidelines for  \nZhao Shi MS and Song Zhang MD contributed equally to this work.  \n􀀍 Lei Wang [867152094@qq.com](867152094@qq.com)  \n􀀍 Ying Lv [lying1999@126.com](lying1999@126.com)  \n􀀍 Xiaoping Zou[zouxp@nju.edu.cn](zouxp@nju.edu.cn)  \n1 Department of Gastroenterology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing 210008, Jiangsu, China  \nthe treatment of gastric cancer, high-grade intraepithelial neoplasia (HGIN) according to the WHO classification is also an EGC and may coexist with invasive adenocarcinomas. Most EGCs can be treated with endoscopic radical therapy, with a 5-year survival rate of over 90%(Isobeet al. 2011), whereas the 5-year survival rate of advanced  \n2 Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Drum Tower Hospital, Medical School of Nanjing University, 321 Zhongshan Road, Nanjing 210008, Jiangsu, China  \n3 Department of Gastroenterology, Clinical College of Traditional Chinese and Western Medicine, Nanjing Drum Tower Hospital, Nanjing University of Chinese Medicine, Nanjing 210008, Jiangsu, China  \n4 Department of General Surgery, Nanjing Drum Tower Hospital, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, Jiangsu, China  \n1 3  \ngastric cancer is less than 30% even after combined surgical treatment (Ajani et al. 2013) . Therefore, early diagnosis and treatment are key measures to improve the survival rate of patients with gastric cancer. In clinical practice, two or more cancerous lesions are often found in the stomach; those found at the s","cbCaimLzKWHVvSwm","https://ap.wps.com/l/cbCaimLzKWHVvSwm","pdf",1063457,"English","# Abstract\n# Aims\n# Method\n# Results\n# Conclusions\n# Introduction\n# Materials and methods\n## Patients","[{\"question\":\"What is the main goal of the study?\",\"answer\":\"To enhance detection of synchronous multiple early gastric cancer by analyzing clinicopathological features, correlations between main and minor lesions, and risk factors for missed diagnoses.\"},{\"question\":\"How were patients selected for analysis?\",\"answer\":\"A cross-sectional review included 130 patients diagnosed with SMEGC or GHGIN among 2,580 patients who underwent endoscopic submucosal dissection (ESD) at Nanjing Drum Tower Hospital, using specified exclusion criteria.\"},{\"question\":\"Which factors were identified as independent risks for missed diagnoses?\",\"answer\":\"Small and non-primary lesions were independent risk factors for missed diagnoses, and the hospital grade at the first gastroscopy was also reported as a risk factor.\"}]","Analysis of clinicopathologic characteristics and risk factors for missed diagnosis in synchronous multiple early gastric cancer | PDF",1790163812,23]