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BACKGROUND: The correlation between fine surface patterns of gastric mucosal lesions and early gastric cancer is not sufficiently clear. OBJECTIVE: To evaluate the efficacy of surface pattern classification by enhanced-magnification endoscopy (EME) for identifying early gastric cancers. DESIGN: Observational study. SETTING: All procedures were performed at Mie University Hospital. PATIENTS: A total of 380 consecutive patients who underwent EGD by using magnification endoscopy. Among these subjects were found 250 newly detected lesions suspected of being gastric cancer. METHODS: Conventional magnification endoscopy (CME), magnification chromoendoscopy (MCE), and EME were performed, and surface patterns of lesions were classified into 5 types: type I, small round pits of uniform size and shape; type II, slit-like pits; type III, gyrus and villous patterns; type IV, irregular arrangement and size; and type V, destructive pattern. Biopsy specimens were obtained from all lesions. MAIN OUTCOME MEASUREMENTS: Correlation between surface pattern classification by EME and histopathologic findings of early gastric cancer. RESULTS: Surface patterns were evident by CME/MCE in only 66.4% (166/250) of lesions but in 100% (250/250) of lesions by EME. Classification by EME was as follows: type I, 52 lesions; type II, 12; type III, 146; type IV, 32; and type V, 8. By histopathologic examination, 16 early gastric cancers were detected between type IV or V lesions. Thus, classification of types IV-V strongly correlated with the presence of gastric cancer (sensitivity 100%, specificity 89.7%). LIMITATIONS: Single-center study. CONCLUSIONS: Surface pattern classification by EME may be useful for identifying early gastric cancers. [ABSTRACT FROM AUTHOR]