{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T04:46:05Z","timestamp":1782708365186,"version":"3.54.5"},"reference-count":118,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:00:00Z","timestamp":1782691200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Early gastric neoplasia represents a clinically decisive but biologically heterogeneous interval in gastric carcinogenesis. Contemporary endoscopy has improved lesion detection and characterization through white-light endoscopy, linked color imaging, blue laser imaging, magnifying narrow-band imaging, and computer-aided systems. Histopathology remains essential for defining dysplasia, invasion depth, differentiation, mucin phenotype, and endoscopic curability. However, most current diagnostic frameworks remain predominantly lesion-centered and incompletely account for the injured mucosal field and host-response context in which early neoplastic lesions arise.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This review aims to synthesize endoscopic, histopathological, microenvironmental, microbial, metabolic, and integrative medicine evidence to propose a lesion\u2013field\u2013host framework for interpreting early gastric neoplasia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Evidence acquisition<\/jats:title>\n                    <jats:p>We reviewed key evidence from endoscopic imaging studies, gastric premalignant lesion guidelines, Helicobacter pylori prevention literature, pathology-continuum studies, metaplasia and SPEM biology, OLGA\/OLGIM and Kyoto-classification research, single-cell and spatial profiling, microbiome and metabolomics studies, digital pathology, and syndrome-related clinical research.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Evidence synthesis<\/jats:title>\n                    <jats:p>The proposed framework comprises three interrelated layers. The lesion layer captures visible and microscopic features of superficial neoplastic disease, including morphology, demarcation line, microvascular and microsurface patterns, biopsy and endoscopic submucosal dissection pathology, differentiation, invasion depth, and curability. The field layer captures background mucosal risk, including H. pylori status, eradication history, atrophy, intestinal metaplasia, SPEM-like metaplastic change, OLGA\/OLGIM stage, Kyoto-classification features, microbiome dysbiosis, and metabolomic remodeling. The host-response layer captures inflammatory, immune, metabolic, nutritional, symptom-based, tongue-image, and syndrome-based variables. Within this layer, traditional Chinese medicine syndrome differentiation is framed as a candidate latent host-response phenotype rather than a substitute for endoscopy or histopathology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Future progress in early gastric neoplasia will likely depend less on isolated biomarkers than on disciplined integration of optical, histological, field-mucosal, and host-response phenotypes. Prospective multicenter validation should incorporate standardized image acquisition, mapping biopsies, OLGA\/OLGIM staging, digital pathology, mucosal microbiome and metabolomic profiling, blinded syndrome assessment, and prediction-model reporting aligned with TRIPOD+AI and PROBAST+AI. This framework may support more rational surveillance, prevention, and integrative risk stratification while avoiding overstatement of currently exploratory syndrome\u2013pathology associations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1889434","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T04:27:00Z","timestamp":1782707220000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Endoscopic and histopathological phenotypes of early gastric neoplasia: toward an integrative host-response framework"],"prefix":"10.3389","volume":"16","author":[{"given":"Ting","family":"Wang","sequence":"first","affiliation":[{"name":"Guang\u2019anmen Hospital South Campus, China Academy of Chinese Medical Sciences","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Zhou","sequence":"additional","affiliation":[{"name":"Guang\u2019anmen Hospital, China Academy of Chinese Medical Sciences","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J Clin"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1111\/den.13684","article-title":"Guidelines for endoscopic diagnosis of early gastric cancer","volume":"32","author":"Yao","year":"2020","journal-title":"Dig Endosc"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s10120-022-01331-8","article-title":"Japanese gastric cancer treatment guidelines 2021 (6th edition)","volume":"26","author":"Japanese Gastric Cancer A","year":"2023","journal-title":"Gastric Cancer"},{"key":"B4","doi-asserted-by":"publisher","first-page":"887","DOI":"10.1097\/cm9.0000000000003101","article-title":"Chinese national clinical practice guidelines on the prevention, diagnosis, and treatment of early gastric cancer","volume":"137","author":"Li","year":"2024","journal-title":"Chin Med J (Engl)"},{"key":"B5","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1055\/s-0031-1291491","article-title":"Management of precancerous conditions and lesions in the stomach (MAPS): guideline from the European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter Study Group (EHSG), European Society of Pathology (ESP), and the Sociedade Portuguesa de Endoscopia Digestiva (SPED)","volume":"460","author":"Dinis-Ribeiro","year":"2012","journal-title":"Virchows Arch"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1055\/a-0859-1883","article-title":"Management of epithelial precancerous conditions and lesions in the stomach (MAPS II): European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter and Microbiota Study Group (EHMSG), European Society of Pathology (ESP), and Sociedade Portuguesa de Endoscopia Digestiva (SPED) guideline update 2019","volume":"51","author":"Pimentel-Nunes","year":"2019","journal-title":"Endoscopy"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1097\/00000478-199610000-00001","article-title":"Classification and grading of gastritis. 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