Accuracy of screening for gastric cancer using serum pepsinogen concentrations

Area of Science:

• Gastroenterology
• Oncology
• Biomarker Research

Background:

• Gastric cancer screening is crucial for early detection and improved outcomes.
• Pepsinogen levels serve as potential biomarkers for gastric mucosal status.
• Establishing reliable cut-off points for pepsinogen screening is essential for accurate gastric cancer identification.

Purpose of the Study:

• To investigate the characteristics of pepsinogen screening for gastric cancer.
• To establish a suitable cut-off point for identifying gastric cancer using endoscopic diagnosis as the reference standard.

Main Methods:

• Serum pepsinogen concentrations (pepsinogen I and pepsinogen II) were measured in 5113 subjects.
• Gastric cancer screening was performed using endoscopy.
• Receiver operator characteristic (ROC) curves were utilized to determine the optimal pepsinogen cut-off points.

Main Results:

• The optimal cut-off points were identified as pepsinogen I < 70 ng/ml and a pepsinogen I/II ratio < 3.0.
• This diagnostic threshold yielded a sensitivity of 84.6% and a specificity of 73.5% for gastric cancer detection.
• While all gastric cancers in severe atrophic gastritis were detected, mild cases, particularly small fundic lesions, were sometimes missed.

Conclusions:

• Pepsinogen screening is a valuable tool for gastric cancer detection, particularly when combined with other methods.
• The established cut-off points provide a practical guideline for implementing pepsinogen screening.
• The simplicity and low cost of pepsinogen assays make them highly suitable for widespread screening programs.