Accuracy of screening for gastric cancer using serum pepsinogen concentrations

Abstract

Background/Aims-The characteristics of pepsinogen screening for gastric cancer were investigated to establish a suitable cut oV point for identifying gastric cancer, using endoscopic diagnosis as the yardstick. Subjects/Methods-Serum pepsinogen concentrations were measured in 5113 subjects who were also screened for gastric cancer by endoscopy. The cut oV point for pepsinogen was determined using receiver operator characteristics curves. Results-The most suitable cut oV point was a pepsinogen I concentration of less than 70 ng/ml and a ratio of pepsinogen I to pepsinogen II of less than 3.0. Using this cut oV point, the sensitivity and specificity of pepsinogen screening for gastric cancer were 84.6% and 73.5% respectively. All cases of gastric cancer in patients with severe atrophic gastritis were detected. However, two of four cases of gastric cancer in patients with mild atrophic gastritis were overlooked. In subjects with mild atrophic gastritis, when gastric cancer arises within the fundic gland region, the size of the lesion determines whether it is possible to detect cancer by serum pepsinogen screening. Conclusion-Pepsinogen screening has many advantages, including its suitability for combination with other screening methods because it is simple and inexpensive. (Gut 1999;44:693-697)

Screening for gastric cancer in Japan

“…Therefore, the two tests gave positive results to largely distinctive subgroups in a population, and detected gastric cancers in different subgroups. Consequently, the sensitivity of serum pepsinogens may be decreased if the test is repeated in the same population, as suggested by the finding of Kitahara et al [45]. In contrast, the sensitivity of photofluorography would not change substantially even when the test is repeated, as they had already been conducted repeatedly in the study populations.…”

“…Studies of serum pepsinogens have so far focused on establishing an optimal cut-off point and quantifying the sensitivity and specificity. Table 7 summarizes studies examining the accuracy of serum pepsinogen measurement in a general population setting [43][44][45]. Table 8 presents the results of two studies comparing the accuracy of photofluorography and serum pepsinogens in a single population [46,47].…”

“…Therefore, a test that is highly sensitive for the initial prevalent screening may be less so for the subsequent incident screenings. Kitahara et al [45] report the accuracy of serum pepsinogens separately in "cross-sectional" and "prospective" evaluations, in which the former basically represents prevalent screening and the latter, incident screening. The observed sensitivity was high in the "cross-sectional" examination (84.6% or 10/13), but was substantially reduced in the "prospective" evaluation (40.0% or 4/10).…”

Tissue metabolomic fingerprinting reveals metabolic disorders associated with human gastric cancer morbidity

“…thus, a full understanding of the molecular mechanism of carcinogenesis and identification of biomarkers for the early diagnosis and effective treatment of human GC are crucial. Although several serum biomarkers have been researched as new invasive tools for screening GC (6)(7)(8)(9), these serum tests are not available as screening or surveillance tests due to their low specificity and sensitivity (9). Biomarkers derived from tumor tissues may provide higher sensitivity and specificity than those from serum (10), yet tissue specimens must be obtained by invasive means involving endoscopy and biopsy.…”

Test and treat or test and scope for Helicobacter pylori infection. Any change in gastric cancer prevention?

“…When measurement of serum Pepsinogen concentrations are used as a screening test for gastric cancer, they achieve a sensitivity of > 80% and specificity of > 70%. 65 Anti-parietal cell antibody is well known as an autoantibody in pernicious anaemia. Anti-parietal cell antibody is also an auto-antibody in H. pylori associated gastritis.…”