Coexistence of early gastric cancer and benign submucosal lesions mimic invasive cancer - a retrospective multicenter experience

Q: What is the study’s main objective regarding early gastric cancer and benign submucosal lesions?

To identify characteristics of coexisting early gastric cancer (EGC) and benign submucosal lesions that mimic invasive cancer, with the goal of reducing adverse consequences from overdiagnosis and overtreatment.

Q: How were patients selected in this retrospective multicenter study?

Patients suspected of early gastric cancer submucosal infiltration were screened using conventional endoscopy, then ultimately selected for endoscopic submucosal dissection after endoscopic ultrasonography and magnifying endoscopy with narrow-band imaging. Included cases had histological confirmation of coexisting EGC and benign submucosal lesions.

Q: What did the study find about diagnostic accuracy and overdiagnosis?

In cases with coexisting EGC and benign submucosal lesions (EGC-SML), the accuracy of judging infiltration depth was significantly lower and the rate of overdiagnosis was significantly higher than in EGC alone.

Sep 24, 2026

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Objective To characterize cases where early gastric cancer (EGC) coexists with benign submucosal lesions and can resemble invasive cancer, aiming to reduce harms from overdiagnosis and overtreatment. Methods A retrospective multicenter study screened endoscopic databases of three tertiary centers, selecting patients with histologically confirmed coexisting EGC and benign submucosal lesions for endoscopic submucosal dissection after EUS and magnifying NBI. Eight endoscopists assessed infiltration depth accuracy. Results Included 18 EGC cases with invasive-like morphology; diagnosis accuracy and overdiagnosis rates were worse in the EGC-SML group. Conclusions Clinicians should recognize this coexistence pattern, especially early cardiac-differentiated cancer with gastritis cystica profunda.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Abstract

Introduction

Diagnostic role of endoscopic submucosal dissection and invasion depth

Imaging modalities and limitations in predicting EGC infiltration depth

Yang et al. BMCGastroenterology (2023) 23:409 [https://doi.org/10.1186/s12876-023-03044-3](https://doi.org/10.1186/s12876-023-03044-3) BMC Gastroenterology RESEARCH Open Access Coexistence of early gastric cancer and benign submucosal lesions mimic invasive cancer: a retrospective multicenter experience Huawei Yang1, Zhen Li1, Zhi Wei2, Guodong Li3, Yi Li2, Shanbin Wu3 and Rui Ji1* Abstract Objective To present a study to identify the characteristics of coexisting early gastric cancer (EGC) and benign submucosal lesions, with the aim of reducing the adverse consequences of overdiagnosis and overtreatment. Methods In this retrospective study, we searched the endoscopic databases of three tertiary centers. We screened of patients suspected of early gastric cancer submucosal infiltration by conventional endoscopy and ultimately selected for endoscopic submucosal dissection treatment after endoscopic ultrasonography and magnifying endoscopy with narrow-band imaging examination. Patients with coexisting EGC and benign submucosal lesions in histological sections were included. Clinical data and endoscopic images were reviewed. To evaluate the precision of endoscopists’ diagnoses for this type of lesion, eight endoscopists with different experiences were recruited to judge the infiltration depth of these lesions and analyze the accuracy rate. Results We screened 520 patients and retrospectively identified 18 EGC patients with an invasive cancer-like morphology. The most common lesion site was the cardia (12/18, 66 . 67%) . The coexisting submucosal lesions could be divided into solid (5/18, 27 . 78%) and cystic (13/18, 72 . 22%) . The most common type of submucosal lesion was gastritis cystica profunda (12/18, 66 . 67%), whereas leiomyoma was the predominant submucosal solid lesion (3/18, 16. 67%) . Ten (55 . 56%) patients < underwent endoscopic ultrasonography; submucosal lesions were definitively diagnosed in 6 patients (60 . 00%) . The accuracy of judgement of the infiltration depth was significantly lower in cases of coexistence of EGC with benign submucosal lesions (EGC-SML) than in EGC (38 . 50% versus 65. 60%, P = 0 . 0167) . The rate of overdiagnosis was significantly higher within the EGC-SML group compared to the EGC group (59 . 17% versus 10. 83%, P < 0. 0001) . Conclusions We should be aware of the coexistence of EGC and benign submucosal lesions, the most common of which is early cardiac-differentiated cancer with gastritis cystica profunda. Keywords Early gastric cancer, Submucosal lesions, Endoscopic ultrasonography, Gastritis cystica profunda, Infiltration depth *Correspondence: Rui Ji [qljirui@email.sdu.edu.cn](qljirui@email.sdu.edu.cn) 1 Department of Gastroenterology, Qilu Hospital of Shandong University, No. 107, Wenhuaxi Road, Jinan 250012, China 2 Shandong Second Provincial General Hospital, Jinan 250022, China 3 The First Affiliated Hospital of Shandong First Medical University, Jinan 250014, China Introduction Endoscopic submucosal dissection (ESD) has been established as a first-line treatment modality for selected early gastric cancer (EGC) . Whether EGC can be treated endoscopically depends mainly on the risk of lymph node metastasis, which correlates with the invasion depth of the tumor [1] . Therefore, accurate © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by

FAQs

What is the study’s main objective regarding early gastric cancer and benign submucosal lesions?

To identify characteristics of coexisting early gastric cancer (EGC) and benign submucosal lesions that mimic invasive cancer, with the goal of reducing adverse consequences from overdiagnosis and overtreatment.

How were patients selected in this retrospective multicenter study?

Patients suspected of early gastric cancer submucosal infiltration were screened using conventional endoscopy, then ultimately selected for endoscopic submucosal dissection after endoscopic ultrasonography and magnifying endoscopy with narrow-band imaging. Included cases had histological confirmation of coexisting EGC and benign submucosal lesions.

What did the study find about diagnostic accuracy and overdiagnosis?

In cases with coexisting EGC and benign submucosal lesions (EGC-SML), the accuracy of judging infiltration depth was significantly lower and the rate of overdiagnosis was significantly higher than in EGC alone.

Sep 24, 2026

Uploaded by Kurz