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Clinicopathological characteristics were evaluated, with lesions classified as main or minor. Correlations between lesions were assessed based on size, location, endoscopic morphology, histopathology, invasion depth, and vascular invasion. Risk factors for missed diagnoses were analyzed.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Of 2580 patients treated with ESD, 130 with SMEGC or GHGIN were included in this study. The sizes of the main and minor lesions were positively correlated (<jats:italic>r<\/jats:italic>\u2009=\u20090.658, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). The main and minor lesions showed moderate consistency in pathological type (kappa\u2009=\u20090.421, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) and low consistency in endoscopic morphology, depth of invasion, and longitudinal position (kappa\u2009&lt;\u20090.4, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05). Of 130 included patients, diagnoses for 37 were missed. Small and non-primary lesions were independent risk factors for missed lesions. We also found that the hospital grade at first gastroscopy was a risk factor for missed diagnosis.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Endoscopists should be aware of the risk factors associated with SMEGC and consider the correlation between the main and minor lesions to prevent the oversight and misdiagnosis of SMEGC.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00432-025-06259-x","type":"journal-article","created":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T09:31:46Z","timestamp":1752139906000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Analysis of clinicopathologic characteristics and risk factors for missed diagnosis in synchronous multiple early gastric cancer"],"prefix":"10.1007","volume":"151","author":[{"given":"Zhao","family":"Shi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Song","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huimin","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Lv","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoping","family":"Zou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,8]]},"reference":[{"key":"6259_CR1","doi-asserted-by":"publisher","first-page":"531","DOI":"10.6004\/jnccn.2013.0070","volume":"11","author":"JA Ajani","year":"2013","unstructured":"Ajani JA, Bentrem DJ, Besh S et al (2013) Gastric cancer, version 2.2013: featured updates to the NCCN Guidelines. 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