Osumi H, et al. - Researchers performed a review focussing on pT1 Epstein-Barr virus-positive gastric cancer (EBVGC) and gastric carcinoma with lymphoid stroma. They investigated expanded endoscopic submucosal dissection (ESD) indication and curative resection criteria in this work. In pT1b EBVGC, a low incidence of lymph node metastasis (LNM) was observed (6/180 patients, 3.3%; 95% confidence interval [CI] 1.2–7.1), particularly in lymphovascular invasion-negative EBVGC (1/109 patients, 0.9%). LNM was not evident among patients with pT1a EBVGC (0/38 patients, 0%; 95% CI 0–7.6), even those patients do not meet the current curative ESD criteria. These findings suggest that EBVGC differs from conventional GC in terms of the clinicopathological characteristics and that EBV negativity is a risk factor for LNM in early GC. Therefore, they suggest patients in this group as promising candidates for ESD, and recommend including EBV status evaluation in early GC treatment guidelines.