Correlation between White Globe Appearance and Clinicopathologic Characteristics in Early Gastric Cancer - Research Summary

Sep 21, 2026

Magnifying endoscopy with narrow-band imaging (ME-NBI) visualizes microsurface (MS) and microvascular (MV) structures in early gastric cancer (EGC), where white globe appearance (WGA) is a small globular whitish lesion. A prospective collection and retrospective analysis evaluated WGA and other ME-NBI findings in 122 patients with 126 EGC lesions. WGA correlated with smaller tumor size (≤2 cm), differentiated histology, and middle-third tumor location. WGA was more often seen with an oval/tubular MS pattern, fine-network MV pattern, and absence of white opaque substances (WOS), though some associations were not statistically significant.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Background/Aims

Methods

Results

WGA prevalence and statistical associations

Relationships with MS/MV patterns and WOS

Conclusions

Key Words

Gut and Liver [https://doi.org/10.5009/gnl240097](https://doi.org/10.5009/gnl240097)[ ](https://doi.org/10.5009/gnl240097)[pISSN 1976-2283 eISSN 2005-1212](pISSN 1976-2283 eISSN 2005-1212) Original Article | Correlation between White Globe Appearance and
Clinicopathologic Characteristics in Early Gastric Cancer
Dae Jin Jung1 , Gwang Ha Kim1 , Kyungbin Kim2 , Hye Kyung Jeon1 , Dong Chan Joo1 , Moon Won Lee1 , Bong Eun Lee1
1Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea; 2Department of Pathology, Pusan National University Hospital, Busan, Korea | | | | --- | --- | --- | | Article Info
Received March 5, 2024
Revised May 9, 2024
Accepted May 19, 2024
Published online October 8, 2024
Corresponding Author
Gwang Ha Kim
ORCID [https://orcid.org/0000-0001-9721-5734](https://orcid.org/0000-0001-9721-5734)[ ](https://orcid.org/0000-0001-9721-5734)[E-mail](E-mail doc0224@pusan.ac.kr)[ doc0224@pusan.ac.kr](E-mail doc0224@pusan.ac.kr) | Background/Aims: Magnifying endoscopy with narrow-band imaging (ME-NBI) enables the visualization of detailed microsurface (MS) and microvascular (MV) structures in the gastrointestinal tract. White globe appearance (WGA) is a small whitish lesion with a globular shape identified during ME-NBI for early gastric cancer (EGC) . This study aimed to investigate the associations between WGA, clinicopathological characteristics, and other ME-NBI findings in patients with EGC.
Methods: The presence or absence of WGA in 122 patients (126 lesions) with an endoscopic diagnosis of EGC who underwent ME-NBI before endoscopic or surgical resection was prospectively collected and retrospectively analyzed. During ME-NBI, the MS and MV patterns and the presence of WGA and white opaque substances (WOS) were investigated. EGC cases were categorized as differentiated or undifferentiated type, and mucosal, submucosal, or advanced. Results: Of 126 lesions, WGA was observed in 25 (19 .8%) . WGA was associated with tumor size (≤2 cm [17/63, 27 .0%] vs >2 cm [8/63, 12.7%]; p=0 .044), histologic type (differentiated type [22/89, 24.7%] vs undifferentiated type [3/37 . 8. 1%]; p=0 .033), and tumor location (upper third [1/11, 9. 1%] vs middle third [18/58, 31.0%] and lower third [6/57, 10.5%]; p=0 .017) . Although WGA was observed more frequently in lesions with an oval/tubular MS pattern, a fine-network MV pattern, and the absence of WOS, the difference was not statistically significant (MS pattern, p=0 .358; MV pattern, p=0 .212; WOS, p=0 . 121, respectively) .
Conclusions: WGA was associated with small tumor size, differentiated-type histology, and middle-third tumor location, and was more frequently observed in lesions with an oval/tubular MSand fine-network MV patterns and the absence of WOS. (Gut Liver 2025;19:50-58)
Key Words: Magnifying endoscopy; Narrow band imaging; Stomach neoplasms; White globe appearance | | |
INTRODUCTION | | mainly showed an oval and/or tubular MS pattern and a fine network or loop MV pattern, while undifferentiated- | | Magnifying endoscopy with narrow-band imaging | | type EGC mainly showed absent MS and corkscrew MV | | (ME-NBI) enables clear visualization of the microsurface | | patterns.2 | | (MS) architecture and microvascular (MV) structures on | | White globe appearance (WGA) is reported as an en- | | the gastric mucosa. Since the vessel plus surface classifica- | | doscopic marker for gastric cancer observed during ME- | | tion system for diagnosing early gastric cancer (EGC) was | | NBI.9 WGA is defined as a small whitish structure with a | | first suggested by Yao et al. ,1 the clinical usefulness of ME- | | globular shape located underneath the gastric epithelium. | | NBI in the diagnosis and characterization of EGC has been | | It is histopathologically associated with intraglandular | | reported.2-8 In our previous

FAQs

What is white globe appearance (WGA) in early gastric cancer?

WGA is a small whitish globular lesion identified during ME-NBI for early gastric cancer. It is defined as a structure located underneath the gastric epithelium and is histopathologically associated with intraglandular necrotic debris.

How many lesions showed WGA, and how was the study designed?

The study included 126 EGC lesions from 122 patients, and WGA was observed in 25 lesions (19.8%). ME-NBI findings were collected prospectively and analyzed retrospectively, focusing on MS and MV patterns and the presence of WOS and WGA before resection.

Which clinicopathologic characteristics were associated with WGA?

WGA was associated with smaller tumor size (≤2 cm), differentiated-type histology, and middle-third tumor location. The associations were statistically significant for tumor size, histologic type, and tumor location.

Sep 21, 2026

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