Since Murakami defined early gastric cancer (EGC) as a“carcinoma limited to the gastric mucosa and/or submucosa regardless of the lymph node status”, several authors have focused on the most inlfuential histopathological parameters for predicting the development of lymph node metastases by considering the lymph node status as an important prognostic factor. A few authors have also considered the depth of invasion as one of the keys to explaining the existence of subgroups of patients affected by EGC with poor prognoses. In any case, EGC is still considered an initial phase of tumor progression with good prognosis. hTe introduction of modern endoscopic devices has allowed a precise diagnosis of early lesions, which can lead to improved deifnitions of tumors that can be radically treated with endoscopic mucosal resection or endoscopic submucosal dissection (ESD). Given the widespread use of these techniques, the Japanese Gastric Cancer Association ( JGCA) identiifed in 2011 the standard criteria that should exclude the presence of lymph node metastases. At that time, EGCs with nodal involvement should have been asserted as no longer iftting the deifnition of an early tumor. Some authors have also demonstrated that the morphological growth pattern of a tumor, according to Kodama’s classiifcation, is one of the most important prognostic factors, thereby suggesting the need to report it in histopathological dratfs. Notwithstanding the acquired knowledge regarding the clinical behavior of EGC, Murakami’s deifnition is still being used. hTis deifnition needs to be upgraded according to the modern staging of the disease so that the appropriate treatment would be selected.
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