Dous C. Diagnostic accuracy in early gastric cancer: Is endoscopic ultrasound staging still reliable? World J Gastroenterol 2026; 32(39): 119757 [DOI: 10.3748/wjg.119757]
Corresponding Author of This Article
Chahrazed Dous, MD, Department of General Surgery, Public Hospital of Theniet El Abed, Daïra of Theniet EL Abed, Batna 5011, Algeria. douschahrazed@yahoo.com
Research Domain of This Article
Gastroenterology & Hepatology
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review-article
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Dous C. Diagnostic accuracy in early gastric cancer: Is endoscopic ultrasound staging still reliable? World J Gastroenterol 2026; 32(39): 119757 [DOI: 10.3748/wjg.119757]
World J Gastroenterol. Oct 21, 2026; 32(39): 119757 Published online Oct 21, 2026. doi: 10.3748/wjg.119757
Diagnostic accuracy in early gastric cancer: Is endoscopic ultrasound staging still reliable?
Chahrazed Dous
Chahrazed Dous, Department of General Surgery, Public Hospital of Theniet El Abed, Batna 5011, Algeria
Author contributions: Dous C contributed to the conceptualization, drafting, and critical revision of the review and approves the final version for publication.
Conflict-of-interest statement: The author reports no relevant conflicts of interest for this article.
Corresponding author: Chahrazed Dous, MD, Department of General Surgery, Public Hospital of Theniet El Abed, Daïra of Theniet EL Abed, Batna 5011, Algeria. douschahrazed@yahoo.com
Received: February 5, 2026 Revised: March 6, 2026 Accepted: April 16, 2026 Published online: October 21, 2026 Processing time: 214 Days and 7.6 Hours
Abstract
Pretreatment assessment of early gastric cancer using endoscopic ultrasound (EUS) is a critical step in selecting the most appropriate treatment for each patient based on the T stage. However, the diagnostic accuracy of EUS for Tis/T1a lesions may be influenced by clinicopathological factors. A recent retrospective study by Qiao et al, including a total of 209 patients, demonstrated that younger age and the presence of ulceration were significantly associated with overstaging of Tis/T1a lesions. In the presence of gastric ulceration, the sensitivity of EUS was markedly reduced, reaching only 41.25%. From a therapeutic perspective, reduced accuracy in pretreatment staging can have important clinical implications. Overestimation of tumor stage in T1a disease may expose patients to unwarranted surgical procedures, while underestimation of T1b tumors may lead to insufficient treatment and an increased risk of recurrence. These findings highlight the need for cautious interpretation of EUS results in this patient population and emphasize the importance of a more comprehensive diagnostic strategy. This article examines these findings from a global perspective and discusses alternative diagnostic approaches.
Core Tip: The choice between endoscopic and surgical treatment in early gastric cancer is based on accurate determination of the depth of tumor invasion. Endoscopic ultrasound has long been considered the most useful tool for this purpose when compared with conventional endoscopy and imaging modalities. However, the accuracy of endoscopic ultrasound in distinguishing between mucosal and submucosal invasion is variable and is influenced by multiple clinicopathological factors. The aim of this article is to discuss this concern and to review other effective diagnostic approaches for assessing invasion depth in early gastric cancer.
