Huang HF, Zeng JQ. Letter to the Editor: Preoperative-pathologic discordance as a structural weakness in early gastric cancer management. World J Gastrointest Oncol 2026; 18(6): 117170 [DOI: 10.4251/wjgo.v18.i6.117170]
Corresponding Author of This Article
Jing-Qi Zeng, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Yangguang South Street, Liangxiang Higher Education Park, Fangshan District, Beijing 102488, China. zjingqi@163.com
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Gastroenterology & Hepatology
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letter
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Huang HF, Zeng JQ. Letter to the Editor: Preoperative-pathologic discordance as a structural weakness in early gastric cancer management. World J Gastrointest Oncol 2026; 18(6): 117170 [DOI: 10.4251/wjgo.v18.i6.117170]
World J Gastrointest Oncol. Jun 15, 2026; 18(6): 117170 Published online Jun 15, 2026. doi: 10.4251/wjgo.v18.i6.117170
Letter to the Editor: Preoperative-pathologic discordance as a structural weakness in early gastric cancer management
Hai-Fu Huang, Jing-Qi Zeng
Hai-Fu Huang, Department of Oncology, Guangzhou University of Chinese Medicine - Shenzhen Hospital, Shenzhen 518034, Guangdong Province, China
Jing-Qi Zeng, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 102488, China
Author contributions: Huang HF contributed to the literature review and drafting of the manuscript; Zeng JQ conceptualized the study, supervised the project, and critically revised the manuscript.
Supported by the Special Fund for Basic Research of Shenzhen City (2025) - Natural Science Foundation Program Project, No. JCYJ20250604190104007; and 2025 Scientific Research Project of the Health System in Futian District, Shenzhen, No. FTWS2025107.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Jing-Qi Zeng, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Yangguang South Street, Liangxiang Higher Education Park, Fangshan District, Beijing 102488, China. zjingqi@163.com
Received: December 1, 2025 Revised: January 10, 2026 Accepted: January 19, 2026 Published online: June 15, 2026 Processing time: 191 Days and 8 Hours
Abstract
Preoperative-pathologic discordance is a structural weakness in early gastric cancer management, with recent data from Jize et al, published in the recent issue of the World Journal of Gastrointestinal Oncology, showing rates exceeding 25%. Such discordance - often driven by proximal location, undifferentiated or mixed histology, lesion heterogeneity, and the limitations of standard biopsy and endoscopic imaging - can lead to non-curative endoscopic resection or to potentially avoidable gastrectomy. These patterns underscore the inadequacy of uniform guideline-based decision-making in capturing true disease biology. Improving accuracy requires explicitly integrating discordance risk into pretreatment pathways. High-risk lesions should undergo intensified assessment, incorporating virtual chromoendoscopy-guided targeted biopsies for histologic heterogeneity and selective endoscopic ultrasonography when deep submucosal invasion is suspected. Regionally calibrated treatment thresholds, second-line pathology review, and emerging artificial-intelligence tools for depth and nodal-risk prediction can further refine therapeutic selection. Recognizing discordance as an anticipated outcome of complex tumor biology - and managing it proactively rather than reactively - is essential for safer, more reliable, and organ-preserving early gastric cancer care.
Core Tip: Preoperative-pathologic discordance is a common and clinically important issue in early gastric cancer management. Clinicians should recognize high-risk features early and escalate diagnostic evaluation when appropriate to preserve organ-sparing treatment options. The use of enhanced diagnostic techniques, such as targeted biopsies, virtual chromoendoscopy, and endoscopic ultrasonography, can significantly improve staging accuracy and help guide better treatment decisions, ultimately reducing unnecessary surgeries.
