Wang J, Chang L, Niu DF, Yan Y, Cao CQ, Li SJ, Wu Q. Diagnostic accuracy of stereomicroscopy assessment of invasion depth in ex vivo specimens of early gastric cancer. World J Gastroenterol 2025; 31(45): 112518 [DOI: 10.3748/wjg.v31.i45.112518]
Corresponding Author of This Article
Qi Wu, MD, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Endoscopy Center, Peking University Cancer Hospital and Institute, No. 52 Fucheng Road, Haidian District, Beijing 100142, China. wuqi1973@bjmu.edu.cn
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Gastroenterology & Hepatology
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Retrospective Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 7, 2025 (publication date) through Dec 6, 2025
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World Journal of Gastroenterology
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1007-9327
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Wang J, Chang L, Niu DF, Yan Y, Cao CQ, Li SJ, Wu Q. Diagnostic accuracy of stereomicroscopy assessment of invasion depth in ex vivo specimens of early gastric cancer. World J Gastroenterol 2025; 31(45): 112518 [DOI: 10.3748/wjg.v31.i45.112518]
World J Gastroenterol. Dec 7, 2025; 31(45): 112518 Published online Dec 7, 2025. doi: 10.3748/wjg.v31.i45.112518
Diagnostic accuracy of stereomicroscopy assessment of invasion depth in ex vivo specimens of early gastric cancer
Jing Wang, Lin Chang, Dong-Feng Niu, Yan Yan, Chang-Qi Cao, Shi-Jie Li, Qi Wu
Jing Wang, Lin Chang, Yan Yan, Chang-Qi Cao, Shi-Jie Li, Qi Wu, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Endoscopy Center, Peking University Cancer Hospital and Institute, Beijing 100142, China
Dong-Feng Niu, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital and Institute, Beijing 100142, China
Co-first authors: Jing Wang and Lin Chang.
Author contributions: Wang J and Chang L contributed equally to this work as co-first authors; Wang J, Chang L, and Wu Q designed the research study; Wang J, Chang L, Niu DF, Yan Y, Cao CQ, and Li SJ performed the research; Wang J and Chang L analyzed the data; all authors contributed to manuscript writing and approved the final version.
Supported by Hygiene and Health Development Scientific Research Fostering Plan of Haidian District Beijing, No. HP2024-19-503002; and Beijing Municipal Administration of Hospitals Incubating Program, No. PX2024041.
Institutional review board statement: The study was reviewed and approved by the Peking University Cancer Hospital Institutional Review Board, No. 2015KT44.
Informed consent statement: All patients provided written informed consent before participation.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Data available from the corresponding author.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qi Wu, MD, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Endoscopy Center, Peking University Cancer Hospital and Institute, No. 52 Fucheng Road, Haidian District, Beijing 100142, China. wuqi1973@bjmu.edu.cn
Received: August 6, 2025 Revised: October 8, 2025 Accepted: November 4, 2025 Published online: December 7, 2025 Processing time: 120 Days and 18.9 Hours
Abstract
BACKGROUND
Endoscopic submucosal dissection (ESD) is an established therapeutic modality for early gastric cancer (EGC). Accurate assessment of the invasion depth is critical for evaluating treatment outcomes.
AIM
To investigate the clinical significance of stereomicroscopy in determining the invasion depth of EGC.
METHODS
This retrospective analysis included 967 patients with EGC who underwent ESD from 2014 to 2023. The mucosal and basal aspects of ESD specimens were stereomicroscopically examined. Lesions were categorized stereomicroscopically as mucosal (uniformly thick, transparent submucosal tissue) or submucosal defined by the presence of a “Basal White Sign”, a localized, opaque, whitish discoloration exceeding 5 mm in diameter. Patients with uncertain classification were excluded. The accuracy of stereomicroscopic depth diagnosis and clinicopathological features of misdiagnosed cases were analyzed.
RESULTS
The overall diagnostic accuracy of stereomicroscopy for invasion depth was 74.0%. For non-ulcerated lesions, stereomicroscopy exhibited high diagnostic performance [accuracy = 93.5%, 95% confidence interval(CI): 91.1-95.4, sensitivity = 95.0%, specificity = 86.9%, positive predictive value = 96.9%, negative predictive value = 80.2%]. Conversely, performance significantly declined in ulcerated lesions (accuracy = 35.8%, 95%CI: 30.2-41.6, sensitivity = 19.1%, specificity = 95.2%, positive predictive value = 93.5%, negative predictive value = 24.8%). Tumor size of 21-30 mm (odds ratio = 1.6) and ulceration (odds ratio = 36.1) were independent risk factors for misdiagnosis. Submucosal lesions exhibited significantly larger basal vessel diameter than mucosal lesions (663.6 μm vs 505.5 μm, P < 0.001).
CONCLUSION
Stereomicroscopy is an effective diagnostic tool for determining the EGC invasion depth, particularly in non-ulcerated lesions. These findings could inform clinical practice and ESD treatment strategy optimization for EGC.
Core Tip: This study demonstrates that stereomicroscopy effectively assesses invasion depth in early gastric cancer, achieving 93.5% accuracy for non-ulcerated lesions, although the overall accuracy was 74.0% and only 35.8% for ulcerated lesions. Tumor size (21-30 mm) and ulceration are key misdiagnosis risk factors. These findings could guide stratified endoscopic submucosal dissection strategy.
