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Serum pepsinogen test for early detection of gastric cancer in a European Country

Lomba-Viana, Rafaela; Dinis-Ribeiro, Máriob; Fonseca, Fernandoa; Vieira, Anabela Silvaa; Bento, Maria José Bentoc; Lomba-Viana, Helenad

European Journal of Gastroenterology & Hepatology: January 2012 - Volume 24 - Issue 1 - p 37–41
doi: 10.1097/MEG.0b013e32834d0a0a
Original Articles: Gastric Disorders

Aim To estimate the adherence of Western individuals to serum pepsinogen (PG) test and its accuracy in the detection of gastric cancer followed by upper gastrointestinal endoscopy.

Methods Individuals from the northern region of Portugal, aged between 40 and 79 years, were invited to participate in a blood collection for the determination of serum PG values by ELISA method (Biohit kits). Participants were classified into two groups: positive (PG I ≤70 ng/ml and PG I/ PGII ≤3) and negative (all others). All participants with a positive test and a consecutive random sample of participants with a negative test were subjected to endoscopy with biopsy. All the participants (positive or negative) subjected to endoscopy were followed up over 5 years.

Results From a total of 13 118 participants, 5326 were men (41%) with a median age of 60 years, and 446 (3.4%) had a positive test. Of these, 274 (61%) were subjected to endoscopy. We observed six gastric cancers, five intestinal and one diffuse type, and three early gastric cancers, representing one cancer per approximately 2200 PG tests or one cancer per 74 positive tests. From these 240 participants with a negative test, three patients with gastric cancer were diagnosed during follow-up (an estimated negative predictive value of 99%). In this study, the PG test showed an estimated sensitivity, specificity, positive predictive value, and negative predictive value of 67, 47, 2, and 99%, respectively.

Conclusion Inhabitants of this high-risk region showed good adherence rate to a gastric cancer detection program based on a PG test followed by upper gastrointestinal endoscopy implemented for the first time. Accuracy estimates were similar to those in Japanese reports, indicating that this methodology could also be used effectively in Western countries with high rates of gastric cancer. Further formal cost-effective studies are however needed.

aPovoa do Varzim, Vila do Conde Hospital

bPorto Faculty of Medicine and Gastroenterology Department, Portuguese Oncology Institute of Porto

cDepartment of Epidemiology, Porto Portuguese Oncology Institute

dPorto Military Hospital

Correspondence to Mário Dinis-Ribeiro, MD, PhD, Department of Gastroenterology, Portuguese Oncology Institute of Porto, Rua Dr Bernardino de Almeida, 4200-072 Porto, Portugal Tel: +351 965 021 582; fax: +351 225 084 055; e-mail: mdinisribeiro@gmail.com

Received July 26, 2011

Accepted September 10, 2011

© 2012 Lippincott Williams & Wilkins, Inc.