Accuracy of screening for gastric cancer using serum pepsinogen concentrations

Background/Aims-The characteristics of pepsinogen screening for gastric can cer 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 subj ects who were also screened for gastric cancer by endoscopy. The cut off po int for pepsinogen was determined using receiver operator characteristics c urves. 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 th an 3.0. Using this cut off point, the sensitivity and specificity of pepsin ogen screening for gastric cancer were 84.6% and 73.5% respectively. All ca ses of gastric cancer in patients with severe atrophic gastritis were detec ted. However, two of four cases of gastric cancer in patients with mild atr ophic 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 pepsinog en screening. Conclusion-Pepsinogen screening has many advantages, including its suitabil ity for combination with other screening methods because it is simple and i nexpensive.