Endoscopic ultrasound in early gastric cancer: Diagnostic accuracy and Tis/T1a lesion over staging risks

doi:10.3748/wjg.v32.i7.116463

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Feb 21, 2026 (publication date) through Feb 6, 2026

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastroenterol. Feb 21, 2026; 32(7): 116463
Published online Feb 21, 2026. doi: 10.3748/wjg.v32.i7.116463

Endoscopic ultrasound in early gastric cancer: Diagnostic accuracy and Tis/T1a lesion over staging risks

Xue-Yan Qiao, Ze-Hua Li, Shi-Yong Lin, Ge Wen

Xue-Yan Qiao, Ge Wen, Department of Medical Imaging, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China

Xue-Yan Qiao, Department of Ultrasound, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, Guangdong Province, China

Ze-Hua Li, Shi-Yong Lin, Department of Endoscopy, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou 510050, Guangdong Province, China

Co-first authors: Xue-Yan Qiao and Ze-Hua Li.

Co-corresponding authors: Shi-Yong Lin and Ge Wen.

Author contributions: Qiao XY and Li ZH prepared the manuscript draft, they contributed equally to this article, they are the co-first authors of this manuscript; Qiao XY, Li ZH and Lin SY collected and analyzed data; Lin SY and Wen G provided research support and revised the manuscript; Lin SY and Wen G designed the research, they contributed equally to this article, they are the co-corresponding authors of this manuscript; all authors read and approved the final manuscript.

Supported by the National Natural Science Foundation of China, No. 82572175 and No. 82172012.

Institutional review board statement: This study was approved by the Medical Ethics Committee of Sun Yat-sen University Cancer Center, approval No. SL-B2025-755-01.

Informed consent statement: All participants were already asked to give signed informed consent before the operation. So, when this retrospective study was checked by the ethics committee, another informed consent was exempt.

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

Data sharing statement: All data generated or analyzed during this study are included in this published article.

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: Ge Wen, MD, Chief Physician, Department of Medical Imaging, Nanfang Hospital, Southern Medical University, No. 1838 North Guangzhou Avenue, Guangzhou 510515, Guangdong Province, China. wenge@smu.edu.cn

Received: November 12, 2025
Revised: November 28, 2025
Accepted: December 22, 2025
Published online: February 21, 2026
Processing time: 86 Days and 13 Hours

Abstract

BACKGROUND

Accurate T-staging of early gastric cancer (EGC) is critical for selecting the most appropriate treatment strategy. Although the reported diagnostic performance of endoscopic ultrasound (EUS) in determining T stage varies among studies, it continues to serve as an important tool in the pretreatment assessment of EGC.

AIM

To identify clinicopathological factors that affect the diagnostic accuracy of EUS in EGC, with particular emphasis on mucosal lesions (Tis/T1a).

METHODS

We included EGC patients who underwent endoscopic resection or gastrectomy. The diagnostic accuracy of EUS was assessed by comparing its T-stage evaluation with the histopathological results of the resected specimens. Additionally, potential risk factors associated with the over staging of Tis/T1a lesions by EUS were investigated.

RESULTS

A total of 209 patients were included in this study. The overall diagnostic accuracy of EUS for T staging was 74.64%. However, the sensitivity of EUS in identifying Tis/T1a gastric cancers was relatively low at 41.25%. Risk factor analysis showed that younger age (P = 0.035) and the presence of ulceration (P < 0.001) were significantly associated with over staging of Tis/T1a lesions. In multivariate analysis, ulceration remained the only independent predictor of over staging, with an odds ratio of 15.25 (95% confidence interval: 3.23-71.98; P < 0.001).

CONCLUSION

The accuracy of EUS for staging Tis/T1a early gastric cancer is markedly reduced when gastric ulceration is present. Therefore, EUS-based staging should be interpreted cautiously in patients with ulcer-related lesions.

Keywords: Endoscopic ultrasound; Early gastric cancer; Tumor staging; Over staging; Diagnostic accuracy

Core Tip: This study demonstrates that gastric ulceration is a major independent risk factor contributing to the over staging of Tis/T1a early gastric cancer by endoscopic ultrasound (EUS). The presence of ulceration markedly reduces the sensitivity of EUS (41.25%) and underscores the need for careful interpretation of EUS findings in ulcer-associated lesions to avoid unnecessary or inappropriate overtreatment.