SinceMurakamidefinedearlygastriccancer(EGC)asa'carcinomalimitedtothegastricmucosaand/orsubmucosaregardlessofthelymphnodestatus',severalauthorshavefocusedonthemostinfluentialhistopathologicalparametersforpredictingthedevelopmentoflymphnodemetastasesbyconsideringthelymphnodestatusasanimportantprognosticfactor.AfewauthorshavealsoconsideredthedepthofinvasionasoneofthekeystoexplainingtheexistenceofsubgroupsofpatientsaffectedbyEGCwithpoorprognoses.Inanycase,EGCisstillconsideredaninitialphaseoftumorprogressionwithgoodprognosis.Theintroductionofmodernendoscopicdeviceshasallowedaprecisediagnosisofearlylesions,whichcanleadtoimproveddefinitionsoftumorsthatcanberadicallytreatedwithendoscopicmucosalresectionorendoscopicsubmucosaldissection(ESD).Giventhewidespreaduseofthesetechniques,theJapaneseGastricCancerAssociation(JGCA)identifiedin2011thestandardcriteriathatshouldexcludethepresenceoflymphnodemetastases.Atthattime,EGCswithnodalinvolvementshouldhavebeenassertedasnolongerfittingthedefinitionofanearlytumor.Someauthorshavealsodemonstratedthatthemorphologicalgrowthpatternofatumor,accordingtoKodama'sclassification,isoneofthemostimportantprognosticfactors,therebysuggestingtheneedtoreportitinhistopathologicaldrafts.NotwithstandingtheacquiredknowledgeregardingtheclinicalbehaviorofEGC,Murakami'sdefinitionisstillbeingused.Thisdefinitionneedstobeupgradedaccordingtothemodernstagingofthediseasesothattheappropriatetreatmentwouldbeselected.
