Published online Dec 7, 2025. doi: 10.3748/wjg.v31.i45.112518
Revised: October 8, 2025
Accepted: November 4, 2025
Published online: December 7, 2025
Processing time: 120 Days and 18.9 Hours
Endoscopic submucosal dissection (ESD) is an established therapeutic modality for early gastric cancer (EGC). Accurate assessment of the invasion depth is cri
To investigate the clinical significance of stereomicroscopy in determining the invasion depth of EGC.
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 fea
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).
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.