Gastric cancer is the fourth most common cancer and the second leading cause of cancer death worldwide. For several decades， the necessity of regular endoscopic examination as a secondary prevention has been emphasized， especially in the area with high prevalence of gastric cancers. For a mass screening program of gastric cancer in Korea and Japan， wide distribution of endoscopy， and increased technique of endoscopy， the early diagnosis of gastric cancer has increased the proportion of the early gastric cancer (EGC).  EGC has been defined as the gastric cancer is limited in the mucosa or submucosa irrespective of other condition.  Meanwhile， endoscopic resection for EGC has been remarkably developed. However， even though the endoscopic resections of EGC have benefit in aspect of organ preserving and quality of life， the application for EGC have been controversial issue because of the potential risk of the lymph node metastasis (LNM). Accurate prediction of lymph node (LN) status is of crucial importance for appropriate treatment planning in patients with early gastric cancer (EGC). However， there is no definitive consensus yet on which patient and/or tumor characteristics are associated with LN metastasis.

 

Depending on the depth of invasion， EGC have 2-5% of the LNM in the mucosal cancer and 10-25% of the LNM in the submucosal cancer. The endoscopic resection is not accepted as the adequate therapy for submucosal gastric cancer due to the relatively high rate of the LNM except for limited condition standing on the expanded indication.  The endoscopic resections for early gastric cancer should be carried out under absence of LNM. Unfortunately， imaging studies including the endoscopic ultrasonography(EUS)， computed tomography(CT) and positron emission tomography(PET) showed unsatisfactory outcome for detecting the LNM. Therefore， the prediction of lymph node metastasis in early gastric cancer (EGC) is difficult and has to be dependent on the patient characteristics and macroscopic/histopathological findings of the tumor. Extensive studies have been performed to determine the risk factors of LNM of early gastric cancer， but those have still debates caused by small numbers and heterogeneities of the subjects. The feasibility of prediction of LNM in EGC will be discussed including the clinicopathologic features related with LNM.