Alkali control of high-grade metamorphism and granitization

We review petrologic observations of reaction textures from high-grade rocks that suggest the passage of fluids with variable alkali activities. Development of these reaction textures is accompanied by regular compositional variations in plagioclase, pyroxenes, biotite, amphibole and garnet. The textures are interpreted in terms of exchange and net-transfer reactions controlled by the K and Na activities in the fluids. On the regional scale, these reactions operate in granitized, charnockitized, syenitized etc. shear zones within high-grade complexes. Thermodynamic calculations in simple chemical systems show that changes in mineral assemblages, including the transition from the hydrous to the anhydrous ones, may occur at constant pressure and temperature due only to variations in the H2O and the alkali activities. A simple procedure for estimating the activity of the two major alkali oxides, K2O and Na2O, is imple- mented in the TWQ software. Examples of calculations are presented for well-documented dehydration zones from South Africa, southern India, and Sri Lanka. The calculations have revealed two end-member regimes of alkalis during specific metamorphic processes： rock buffered, which is characteristic for the precursor rocks containing two feldspars, and fluid-buffered for the precursor rocks without K-feldspar. The observed reaction textures and the results of thermodynamic modeling are compared with the results of available experimental studies on the interaction of the alkali chloride and carbonate-bearing fluids with metamorphic rocks at mid-crustal conditions. The experiments show the complex effect of alkali activities in the fluid phase on the mineral assemblages. Both thermodynamic calculations and experiments closely reproduce paragenetic relations theoretically predicted by D.S. Korzhinskii in the 1940s.

Role of pancreatic juice cytology in diagnosis of high-grade pancreatic intraepithelial neoplasia

High-grade pancreatic intraepithelial neoplasia is a challenging diagnosis and itdoes not exhibit mass lesions. It is suspected based on changes in the mainpancreatic duct in magnetic resonance cholangiopancreatography. Sometimesonly an unclear duct shows in magnetic resonance cholangiopancreatographywith no focal strictures and upstream dilatation of the main pancreatic duct. Serialpancreatic juice cytology is valuable in diagnosis of those patients.

Multimodal artificial intelligence system for detecting a small esophageal high-grade squamous intraepithelial neoplasia: A case report

BACKGROUND Recent advancements in artificial intelligence(AI)have significantly enhanced the capabilities of endoscopic-assisted diagnosis for gastrointestinal diseases.AI has shown great promise in clinical practice,particularly for diagnostic support,offering real-time insights into complex conditions such as esophageal squamous cell carcinoma.CASE SUMMARY In this study,we introduce a multimodal AI system that successfully identified and delineated a small and flat carcinoma during esophagogastroduodenoscopy,highlighting its potential for early detection of malignancies.The lesion was confirmed as high-grade squamous intraepithelial neoplasia,with pathology results supporting the AI system’s accuracy.The multimodal AI system offers an integrated solution that provides real-time,accurate diagnostic information directly within the endoscopic device interface,allowing for single-monitor use without disrupting endoscopist’s workflow.CONCLUSION This work underscores the transformative potential of AI to enhance endoscopic diagnosis by enabling earlier,more accurate interventions.

A Problem of High-Grade Polymetamorphism

A problem of evolution of high-grade polymeta- morphic terrain appeared in last decades:in worldwide complexes the identification of true stages of polymetamorphism encounters a problem of zircon zoning(or garnet etc.)that is the function of fluid activity and therefore the newly formed zone can not always be recorded.Structural geology allows discriminating between different stages of metamor-

High-grade pancreatic intraepithelial neoplasia diagnosed based on changes in magnetic resonance cholangiopancreatography findings:A case report

BACKGROUND High-grade pancreatic intraepithelial neoplasia(PanIN)exhibits no mass and is not detected by any examination modalities.However,it can be diagnosed by pancreatic juice cytology from indirect findings.Most previous cases were diagnosed based on findings of a focal stricture of the main pancreatic duct(MPD)and caudal MPD dilatation and subsequent pancreatic juice cytology using endoscopic retrograde cholangiopancreatography(ERCP).We experienced a case of high-grade PanIN with an unclear MPD over a 20-mm range,but without caudal MPD dilatation on magnetic resonance cholangiopancreatography(MRCP).CASE SUMMARY A 60-year-old female patient underwent computed tomography for a follow-up of uterine cancer post-excision,which revealed pancreatic cysts.MRCP revealed an unclear MPD of the pancreatic body at a 20-mm length without caudal MPD dilatation.Thus,course observation was performed.After 24 mo,MRCP revealed an increased caudal MPD caliber and a larger pancreatic cyst.We performed ERCP and detected atypical cells suspected of adenocarcinoma by serial pancreatic juice aspiration cytology examination.We performed a distal pancreatectomy and obtained a histopathological diagnosis of high-grade PanIN.Pancreatic parenchyma invasion was not observed,and curative resection was achieved.CONCLUSION High-grade Pan-IN may cause MPD narrowing in a long range without caudal MPD dilatation.

Bulk geochemistry,Rb-Sr,Sm-Nd,and stable O-H isotope systematics of the Metzimevin high-grade iron ore deposit,Mbalam iron ore district,southern Cameroon

Bulk geochemistry,Sr,Nd,and O-H isotope systematics are reported for the first time on banded iron formation(BIF)-hosted high-grade iron ore at the northwestern segment of Congo Craton(CC).Located in Mbalam iron ore district,Southern Cameroon,Metzimevin iron ore deposit is a hematite-magnetite BIF system,dominated by SiO_(2)+Fe_(2)O_(3)(97.1 to 99.84 wt%),with low concentrations of clastic elements e.g.,Al_(2)O_(3),TiO_(2),and HFSE,depicting a nearly pure chemical precipitate.The REE+Y signature of the iron deposit displays strong positive Eu anomaly,strong negative Ce anomaly,and chondritic to superchondritic Y/Ho ratios,suggestive of formation by mixed seawater-high temperature hydrothermal fluids in oxidising environment.The^(87)Sr/^(86)Sr ratios of the BIF are higher than the maximum^(87)Sr/^(86)Sr evolution curves for all Archean reservoirs(bulk silicate earth,Archean crust and Archean seawater),indicating involvement of continentally-derived components during BIF formation and alteration.TheƐ_(Nd)(t)(+2.26 to+3.77)and Nd model age indicate that chemical constituents for the BIF were derived from undifferentiated crustal source,between 3.002 and 2.88 Ga.The variable and diverse O and H isotope data(−1.9‰to 17.3‰and−57‰to 136‰respectively)indicate that the Metzimevin iron ore formed initially from magmatic plumes and later enriched by magmatic-metamorphic-modified meteoric fluids.Mass balance calculations indicate mineralisation by combined leaching and precipitation,with an average iron enrichment factor of>2.67 and SiO_(2)depletion factor of>0.99.This is associated with an overall volume reduction of 28.27%,reflecting net leaching and volume collapse of the BIF protholith.

Management of retroperitoneal high-grade serous carcinoma of unknown origin:A case report

BACKGROUND Retroperitoneal high-grade serous carcinoma(HGSC)of unknown origin is a sporadic tumor that can originate from ovarian cancer.Herein,we report the case of a woman with retroperitoneal HGSC of unknown origin and describe how she was diagnosed and treated.CASE SUMMARY A 71-year-old female presented with the tumor marker CA125 elevated to 1041.9 U/mL upon a regular health examination.Computed tomography revealed retroperitoneal lymph node enlargement.Subsequently,positron emission tomography scanning revealed lesions with increased F-18 fluorodeoxyglucose uptake at the nodes.As a result,she underwent laparoscopic lymph node resection,and pathology revealed metastatic adenocarcinoma with CK7(+),PAX8(+),WT1(+),PR(-),and p53 mutational loss of expression,indicating that the origin may be from the adnexa.The patient was admitted to our ward and underwent laparoscopic staging;however,the pathological results were negative.Under the suspicion of retroperitoneal HGSC of unknown origin,chemotherapy and targeted therapy were initiated.Tumor marker levels decreased after treatment.CONCLUSION We present a case of HGSC of unknown origin managed using retroperitoneal lymphadenectomy,staging surgery,chemotherapy,and targeted therapy.

Characteristics and risk factor analyses of high-grade intraepithelial neoplasia in older patients with colorectal polyps

BACKGROUND According to the degree of intradermal neoplasia in the colorectal exhalation,it can be divided into two grades:Low-grade intraepithelial neoplasia(LGIN)and high-grade intraepithelial neoplasia(HGIN).Currently,it is difficult to accurately diagnose LGIN and HGIN through imaging,and clinical diagnosis depends on postoperative histopathological diagnosis.A more accurate method for evaluating HGIN preoperatively is urgently needed in the surgical treatment and nursing intervention of colorectal polyps.AIM To explore the characteristics and risk factors of HGIN in older patients with colorectal polyps.METHODS We selected 84 older patients diagnosed with HGIN as the HGIN group(n=95 colonic polyps)and 112 older patients diagnosed with LGIN as the LGIN group(n=132 colonic polyps)from Shandong Provincial Hospital Affiliated to Shandong First Medical University.The endoscopic features,demographic characteristics,and clinical manifestations of the two patient groups were compared,and a logistic regression model was used to analyze the risk factors for HGIN in these patients.RESULTS The HGIN group was older and had a higher number of sigmoid colon polyps,rectal polyps,pedunculated polyps,polyps≥1.0 cm in size,polyps with surface congestion,polyps with surface depression,and polyps with villous/tubular adenomas,a higher proportion of patients with diabetes and a family history of colorectal cancer,patients who experienced rectal bleeding or occult blood,patients with elevated carcinoembryonic antigen(CEA)and cancer antigen 199(CA199),and lower nutritional levels and higher frailty levels.The polyp location(in the sigmoid colon or rectum),polyp diameter(≥1.0 cm),pathological diagnosis of(villous/tubular adenoma),family history of colorectal cancer,rectal bleeding or occult blood,elevated serum CEA and CA199 levels,lower nutritional levels and higher frailty levels also are independent risk factors for HGIN.CONCLUSION The occurrence of high-grade neoplastic transformation in colorectal polyps is closely associated with their location,size,villous/tubular characteristics,family history,elevated levels of tumor markers,and lower nutritional levels and higher frailty levels.

High-grade serous carcinoma of the fallopian tube in a young woman with chromosomal 4q abnormality:A case report

BACKGROUND Few studies have reported an association between an increased risk of acquiring cancers and survival in patients with 4q deletion syndrome.This study presents a rare association between chromosome 4q abnormalities and fallopian tube highgrade serous carcinoma(HGSC)in a young woman.CASE SUMMARY A 35-year-old woman presented with acute dull abdominal pain and a known chromosomal abnormality involving 4q13.3 duplication and 4q23q24 deletion.Upon arrival at the emergency room,her abdomen appeared ovoid and distended with palpable shifting dullness.Ascites were identified through abdominal ultrasound,and computed tomography revealed an omentum cake and an enlarged bilateral adnexa.Blood tests showed elevated CA-125 levels.Paracentesis was conducted,and immunohistochemistry indicated that the cancer cells favored an ovarian origin,making us suspect ovarian cancer.The patient underwent debulking surgery,which led to a diagnosis of stage IIIC HGSC of the fallopian tube.Subsequently,the patient received adjuvant chemotherapy with carboplatin and paclitaxel,resulting in stable current condition.CONCLUSION This study demonstrates a rare correlation between a chromosome 4q abnormality and HGSC.UBE2D3 may affect crucial cancer-related pathways,including P53,BRCA,cyclin D,and tyrosine kinase receptors,thereby possibly contributing to cancer development.In addition,ADH1 and DDIT4 may be potential influencers of both carcinogenic and therapeutic responses.

Transformation of marginal zone lymphoma into high-grade B-cell lymphoma expressing terminal deoxynucleotidyl transferase:A case report

BACKGROUND High-grade B-cell lymphoma(HGBL)is an unusual malignancy that includes myelocytomatosis viral oncogene(MYC),B-cell lymphoma-2(BCL-2),and/or BCL-6 rearrangements,termed double-hit or triple-hit lymphomas,and HGBL-not otherwise specific(HGBL-NOS),which are morphologically characteristic of HGBL but lack MYC,BCL-2,or BCL-6 rearrangements.HGBL is partially transformed by follicular lymphoma and other indolent lymphoma,with few cases of marginal zone lymphoma(MZL)transformation.HGBL often has a poor prognosis and intensive therapy is currently mainly advocated,but there is no good treatment for these patients who cannot tolerate chemotherapy.CASE SUMMARY We reported a case of MZL transformed into HGBL-NOS with TP53 mutation and terminal deoxynucleotidyl transferase expression.Gene analysis revealed the gene expression profile was identical in the pre-and post-transformed tissues,suggesting that the two diseases are homologous,not secondary tumors.The chemotherapy was ineffective and the side effect was severe,so we tried combination therapy including venetoclax and obinutuzumab.The patient tolerated treatment well,and reached partial response.The patient had recurrence of hepatocellular carcinoma and died of multifunctional organ failure.He survived for 12 months after diagnosis.CONCLUSION Venetoclax combined with obinutuzumab might improve the survival in some HGBL patients,who are unsuitable for chemotherapy.

Metabasic Dyke Swarms in a High-Grade Metamorphic Terrane——A Case Study in the Taipingzhai-Jinchangyu Area,Eastern Hebei Province

Geological and petrological studies indicate that three phases of metabasic dykes are present in theTaipingzhai-Jinchangyu area within the high-grade metamorphic terrane of eastern Hebei. Garnet andhornblende in metabasic dykes of the second and third phases occur separately, forming two mineral aggregateareas gl+cpx+pl±hy and hb+cpx+pl-hy. P_(H_2O) in the rocks appears to be the main factor controlling theformation of the two aggregate areas. Both were formed simultaneously at the same metamorphic temperature. The second-phase basic dykes underwent metamorphism of pyroxene-granulite facies at a temperature ofsome 825C: later the dykes, together with the third-phase basic dykes experienced metamorphism ofamphibole-granulite facies at a temperature of about 750C under pressure of 0.9GPa.

Study on Plants Selection and Disposition in High-grade Residences

With rapid development of economy and emergence of more and more high-grade residences,it had highlighted that high-grade residence was the inevitable tendency of economic development and urban construction.Based on the fact that high-grade residences paid more attention to harmony of human and architecture with nature and required higher for landscaping,the paper emphasized that landscape quality of high-grade residences was the key factor deciding quality of the residence.In view of insufficiencies of plant landscaping planning in high-grade residences at home and abroad,by taking high-grade residences in Hangzhou City for example,analysis had been conducted by selecting typical cases.It pointed out that plants disposition in high-grade residences was unreasonable,architectures and landscapes were isolated,and greening ratio was stressed while design was neglected.And then,corresponding solutions had been proposed.In terms of plants selection,it should reasonably utilize native tree species,and properly select new and high-quality plant species.In terms of harmonious unity between plant landscape and architecture,it should lay stress on unity between sensory design and comfort design.In terms of plant design and disposition,it should stick to the theme of "residential environment",so as to rationalize plant design and disposition,and create more comfortable residential environment.

TWO EPISODES OF MONAZITE CRYSTALLIZATION DURING METAMORPHISM AND CRUSTAL MELTING IN THE EVEREST REGION OF THE NEPALESE HIMALAYA

New monazite U\|Pb geochronological data from the Everest region suggest that 20～25Ma elapsed between the initial India—Asia collision and kyanite\|sillimanite grade metamorphism. Our results indicate a two\|phase metamorphic history, with peak Barrovian metamorphism at (32 2±0 4)Ma and a later high\|temperature, low\|pressure event (620℃, 400MPa) at (22 7±0 2)Ma.. Emplacement and crystallization of the Everest granite subsequently occurred at 20 5～21 3Ma. The monazite crystallization ages that differ by 10Ma are recorded in two structurally adjacent rocks of different lithology, which have the same post collisional p—T history.. Scanning electron microscopy reveals that the younger monazite is elaborately shaped and grew in close association with apatite at grain boundaries and triple junctions, suggesting that growth was stimulated by a change in the fluid regime. The older monazite is euhedral, is not associated with apatite, and is commonly armoured within silicate minerals. During the low\|pressure metamorphic event, the armouring protected the older monazites, and a lack of excess apatite in this sample prevented new growth. Textural relationships suggest that apatite is one of the necessary monazite\|producing reactants, and spots within monazite that are rich in Ca, Fe, Al and Si suggest that allanite acted as a preexisting rare earth element host. We propose a simplified reaction for monazite crystallization based on this evidence.

Metamorphism of the East Sector of the Southern Qinling Orogenic Belt and Its Geological Significance

The east sector of the southern Qinling belt is, lithologically, composed mainly of metapelites, ***qüartzites, marbles and small amount of metabasites and gneisses, whose protoliths are the Silurian, Devonian and less commonly the Sinian and Upper Palaeozoic. They have been subjected at least to two epochs of metamorphism. The early epoch belongs to progressive metamorphism which is centered on high amphibolite-granulite fades in the Fuping area and changed outwards into low amphibolite facies (staurolite-kyanite zone), epidote amphibolite facies (garnet zone) and greenschist facies (chlorite and biotite zones), the metamorphic age of which is about 220–260 Ma. This early-epoch metamorphism belongs to different pressure types: the rocks from greenschist to low amphibolite facies belong to the typical medium-pressure type which shows geothermal gradients of about 17–20 ***C/km and was probably produced by a crustal thickening process related to continental collision, and the high amphibolite-granulite facies belongs to the low-pressure type which shows geothermal gradients of about 25–38 ***C/km and was probably affected by some magmatic heats. Based on the basic characteristics of the P-T paths of the different facies calculated from the garnet zonations, it can be deduced that the metamorphism of medium-pressure facies series took place during an imbricated thickening process, rather than during the uplifting process after thickening. The late-epoch metamorphism belongs to dynamic metamorphism of greenschist facies which is overprinted on the early-epoch metamorphic rocks and is Yanshanian or Himalayan in age, probably related to intracontinental orogeny.

High- and Ultrahigh-pressure Metamorphism and Retrogressive Textures of Gneiss in the Donghai Area——Evidence from gneisses in drillhole ZK2304

In the gneisses from the drillhole ZK2304 of the Donghai area, there have been preserved high- and ultrahigh-pressure metamorphic mineral assemblages, a series of complicated retrogressive textures and relevant metamorphic reactions. In addition to garnet, jadeititic-clinopyroxene and rutile, other peak stage (M2) minerals in some gneisses include phengite, aragonite and coesite or quartz pseudomorphs after coesite. The typical peak-stage mineral assemblages in gneisses are characterized by garnet + jadeitic-clinopyroxene + rutile + coesite, garnet + jadeitic-clinopyroxene + phengite + rutile ± coesite and garnet + jadeitic-clinopyroxene + aragonite + rutile ± coesite. The grossular content (Gro) in garnet is high and may reach 50. 1 mol%. The SiO2 content of phengite ranges from 54.37% to 54.84% with 3.54-3.57 p.f.u. Quartz pseudomorphs after coesite occur as inclusions in garnet.The gneisses of the Donghai area have been subjected to multistage recrystallization and exhibit a closewise P-T evolutional path characterized by the near-isothermal decompression. The inclusion assemblage (Hb+Ep+Bi+Pl+Qz) within garnet and other minerals has recorded a pre-peak stage (Mi) epidote amphibole fades metamorphic event. High- and ultrahigh-pressure peak metamorphism (M2) took place at T=750-860℃ and P>2.7 GPa. The symplectitic assemblages after garnet, jadeitic-clinopyroxene and rutile imply a near-isothermal decompression metamorphism (M3, M4) during the rapid exhumation. Several lines of evidence of petrography and metamorphic reactions indicate that both gneisses and eclogites have experienced ultrahigh-pressure metamorphism in the Donghai area. This research may be of great significance for an in-depth study of the metamorphism and tectonic evolution in the Su-Lu ultrahigh-pressure metamorphic belt.

Eclogites of the Dabie Region: Retrograde Metamorphismand Fluid Evolution

Based upon fluid effects, retrograde metamorphism of eclogites in the Dabieregion can be divided into the fluid-poor, fluid-bearing and fluid-rich stages. The fluid-poor stageis marked by polymorphic inversion, recrystallization and exsolution of solid solutions, and isthought to represent eclogite-facies retrograde environments. The fluid-bearing stage is likely tohave occurred at the late stage of ecologite-facies diaphthorosis and is represented by kyaniteporphyroblasts, rutile, and sodic pyroxene in association with high-pressure hydrous minerals suchas phengite and zoisite (clinozoisite) without significant amount of hydrous minerals such asamphibole, epidote and biotite. The fluid-rich stage might have commenced concomitantly with loweramphibolite-facies diaphthoresis and persisted all the way towards the near-surface environment. Theproduct of this stage is characterized by plentiful hydrous and volatile-bearing phases.The dissemination-type rutile mineralizations in eclogites might have formed by preferentialshearing-induced pressure solution of gangue minerals at the fluid-bearing stage. The accompanyingvein rutile was precipitated from fluids of this stage after local transport and concentration, andmay hence represent proximal mobilization of titanium from the eclogite. Therefore, rutile veins canbe used as an exploration indicator for dissemination-type rutile deposits.

Diagenesis and Metamorphism of Triassic Flysch Along Profile Zoige-Lushan,Northwest Sichuan,China

We used illite and chlorite crystaHinities, index minerals, mineral assemblages, polytype and domain size of white mica, electron microprobe analysis （EMPA）, b0 geobarometer and chlorite geothermometer to quantify the diagenetic and metamorphic overprint on the Triassic flysch formations in the Songpan-Garze orogen along profile Zoige-Lushan, northwest Sichuan. Two anchizones, two epizones, one diagenetic zone and a transition belt in-between them are defined on the basis of the obtained data. lllite crystallinity correlates strongly with the best mean domain size of mica and moderately with chlorite crystallinity. 2M1 white mica polytype are observed within the epizone whilst 2M1 and 1M polytypes occur in the anchizone and diagenetic zone. Epizonal metamorphism reached maximum temperatures of 370℃±21℃ at low-to intermediate pressure conditions. Clay minerals underwent Ostwald ripening during metamorphism. Rocks from both sides of the Longmenshan fault reveal contrasting degrees of metamorphic overprint： on the northwest side of the Longmenshan fault, epimetamorphic conditions contrast with diagenetic rocks on the southeast side.

Mineralogical Evidence for Regional Metamorphism Overprinted by Contact Metamorphism

The Soursat metamorphic complex （SMC） in northwestern Iran is part of the Sanandaj- Sirjan metamorphic belt. The complex is composed of different metamorphic and plutonic rocks, but is dominated by metapelites composed of garnet, staurolite, kyanite, fibrolite, cordierite, and andalusite. Porphyroblasts in schists have the same fabric, and three stages of schistosity are present. The internal schistosity （Sn） inclusion trails are also offset by conjugate sets of extensional schistosity （Sn＋l） and a second （Sn＋2） that crenulates （Sn＋l）. Polyphase metamorphisms are present in the complex. Garnet, staurolite, kyanite, and fibrolite assemblage preserves conditions during the M1 metamorphic event. This assemblage yields a P-t estimate of 645±11℃ and 6.5±0.5 kbar. Other samples of the central part of SMC contain cordierite and andalusite （M2） overgrowth that yields a P- t estimate of 532±33℃ and 2.1±1.1 kbar.

Precambrian Metamorphism of Tiya－Olokit Metamorphic Belt in Northern Balkal Region and its Metallogeny

The paper deals with results of petrological observations of the Precambrian rocks in the Tiya-Olokit metamorphic belt of the Northern Balkal region. Evoluhon of mstamorphic processes from Archean through to Paleozoic is characterized. Interrelations of metamorphic and ore formation processes are shown .Various genetic types of metamorphism and their metallogeulc speianzation (pyrihc-polylnetallic, gold-sulphide and others) are established.A great number of previously published analyses of garnets, biohtes, amphiholes, pyroxenes and muscovitde from metamorphic rocks have been made use of. The evoluhon of their compositions under progressive zoned metamorphism and diaphthoresis is revealed.

Missed diagnosis of early gastric cancer or high-grade intraepithelial neoplasia

AIM: To investigate the causes of missed diagnosis of early gastric cancer (EGC) or high-grade intraepithelial neoplasia (HGIN) in Chongqing, China. METHODS: The present study summarizes 103 cases of EGC/HGIN detected by esophagogastroduodenos-copy (EGD) and pathological analysis from January 2010 to December 2011. Dimethyl silicone oil was administrated orally 15 min before the EGD procedures. The stomach was cleaned by repeated washing with saline when the gastroscope entered the stomach cavity. Suspected EGC lesions were subject to conventional biopsy sampling and pathological examinations. The correlation between lesion locations, endoscopic morphology of cancerous sites, training level of the examiners, pathological biopsies, and missed diagnosis was analyzed. RESULTS: Twenty-three cases were missed among the 103 cases (22.23%) of EGC/HGIN. The rate of missed EGC in the gastroesophageal junction (8/19, 42.1%) was significantly higher than at other sites (15/84, 17.86%) (χ2 = 5.253, P = 0.022). In contrast, the rate of missed EGC in the lower stomach body (2/14, 14.29%) was lower than at other sites (21/89,23.6%), but there were no significant differences (χ2 = 0.289, P = 0.591). The rate of missed EGC in the gastric antrum (5/33, 15.15%) was lower than at other sites (18/70, 25.71%), but there were no significant differences (χ2 = 1.443, P = 0.230). Endoscopists from less prestigious hospitals were more prone to not diagnosing EGC than those from more prestigious hospitals (χ2 = 4.261, P = 0.039). When the number of biopsies was < 4, the rate of missed diagnosis was higher (20/23, 89.96%) than for when there were > 4 biopsies (3/23, 13.04%) (P < 0.001). In addition, there was no significant difference in the rate of missed diagnosis in patients with 1-3 biopsy specimens (χ2 = 0.141, P = 0.932). CONCLUSION: Endoscopists should have a clear understanding of the anatomical characteristics of the esophagus/stomach, and endoscopic identification of early lesions increases with the number of biopsies.