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. 1999 May;44(5):693–697. doi: 10.1136/gut.44.5.693

Accuracy of screening for gastric cancer using serum pepsinogen concentrations

F Kitahara 1, K Kobayashi 1, T Sato 1, Y Kojima 1, T Araki 1, M Fujino 1
PMCID: PMC1727514  PMID: 10205207

Abstract

BACKGROUND/AIMS—The characteristics of pepsinogen screening for gastric cancer were investigated to establish a suitable cut off 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 off point for pepsinogen was determined using receiver operator characteristics curves. 
RESULTS—The most suitable cut off 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 off 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. 



Keywords: pepsinogen; gastric cancer; screening; cut off point; receiver operator characteristics curves; atrophic gastritis

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Figure 1 .

Figure 1

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Classification of chronic atrophic gastritis according to the location of the border between the fundic and pyloric gland regions by endoscopy: C1, at the angular part of the lesser curvature; C2, in the lower part of the lesser curvature; C3, in the middle part of the lesser curvature; O1, all parts of the lesser curvature are pyloric; O2, the stage between O1 and O3; O3, all mucosa of the stomach is non-acid-secreting. 


Figure 2 .

Figure 2

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Receiver operator characteristics (ROC) curves generated with serum pepsinogen (PG) I concentrations alone, PG II concentrations alone, and I:II ratios alone (A), various serum PG I concentrations or I:II ratios (B), the combination of various serum PG I concentrations and I:II ratios (C), and by changing the serum PG I concentration from 30 to 80 ng/ml, the PG II concentration from 5 to 30 ng/ml, and the I:II ratio from 2.0 to 4.0 intermittently. The following cut off points are found to be suitable: a I:II ratio of less than 3.0 alone (A), a PG I concentration of less than 30 ng/ml or a I:II ratio of less than 3.0 (B), a PG I concentration of less than 70 ng/ml and a I:II ratio of less than 3.0 (C). 


Figure 3 .

Figure 3

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Distribution of serum pepsinogen (PG) I concentrations and I:II ratios in all subjects. White circles denote cases of gastric cancer. Of 13 gastric cancer cases, 11 would have been detected by the serum PG method, using a PG I concentration of less than 70 ng/ml and a I:II ratio of less than 3.0 as the cut off point. 


Figure 4 .

Figure 4

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Distribution of nine cases of gastric cancer in patients with severe atrophic gastritis. White lesions are differentiated and black are undifferentiated. These nine cases were detected by serum pepsinogen (PG) screening for gastric cancer, using a serum PG I concentration of less than 70 ng/ml and a I:II ratio of less than 3.0 as the cut off point. B-2, Borrmann type 2; B-3, Borrmann type 3; IIc-adv, advanced cancer resembling type IIc. Borderline, border between fundic and pyloric regions. 


Figure 5 .

Figure 5

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Distribution of four cases of gastric cancer in subjects with mild atrophic gastritis. The white lesions are differentiated, and the grey lesions are undifferentiated. Two of the four cases could not be detected by serum pepsinogen (PG) screening using a serum PG I concentration of less than 70 ng/ml and a I:II ratio of less than 3.0 as the cut off point. B-4, Borrmann type 4. Borderline, borderline between fundic and pyloric regions. 


Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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