TY - JOUR
T1 - Assessment of Serum Pepsinogens with and without Co-Testing with Gastrin-17 in Gastric Cancer Risk Assessment—Results from the GISTAR Pilot Study
AU - Robles, Claudia
AU - Rudzite, Dace
AU - Polaka, Inese
AU - Sjomina, Olga
AU - Tzivian, Lilian
AU - Kikuste, Ilze
AU - Tolmanis, Ivars
AU - Vanags, Aigars
AU - Isajevs, Sergejs
AU - Liepniece-Karele, Inta
AU - Razuka-Ebela, Danute
AU - Parshutin, Sergej
AU - Murillo, Raul
AU - Herrero, Rolando
AU - Young Park, Jin
AU - Leja, Marcis
N1 - Funding Information:
The work was partly supported by the Latvian Council of Science (Project No. LZP-2018/1-0135, “Research on implementation of a set of measures for prevention of gastric cancer mortality by eradication of H. pylori and timely recognition of precancerous lesions”).
Publisher Copyright:
© 2022 by the authors.
PY - 2022/7
Y1 - 2022/7
N2 - Introduction––Serum pepsinogen tests for gastric cancer screening have been debated for decades. We assessed the performance of two pepsinogen assays with or without gastrin-17 for the detection of different precancerous lesions alone or as a composite endpoint in a Latvian cohort. Methods––Within the intervention arm of the GISTAR population-based study, participants with abnormal pepsinogen values by ELISA or latex-agglutination tests, or abnormal gastrin-17 by ELISA and a subset of subjects with all normal biomarker values were referred for upper endoscopy with biopsies. Performance of biomarkers, corrected by verification bias, to detect five composite outcomes based on atrophy, intestinal metaplasia, dysplasia or cancer was explored. Results––Data from 1045 subjects were analysed, of those 273 with normal biomarker results. Both pepsinogen assays showed high specificity (>93%) but poor sensitivity (range: 18.4–31.1%) that slightly improved when lesions were restricted to corpus location (40.5%) but decreased when dysplasia and prevalent cancer cases were included (23.8%). Adding gastrin-17 detection, sensitivity reached 33–45% while specificity decreased (range: 61.1–62%) and referral rate for upper endoscopy increased to 38.6%. Conclusions––Low sensitivity of pepsinogen assays is a limiting factor for their use in population-based primary gastric cancer screening, however their high specificity could be useful for triage.
AB - Introduction––Serum pepsinogen tests for gastric cancer screening have been debated for decades. We assessed the performance of two pepsinogen assays with or without gastrin-17 for the detection of different precancerous lesions alone or as a composite endpoint in a Latvian cohort. Methods––Within the intervention arm of the GISTAR population-based study, participants with abnormal pepsinogen values by ELISA or latex-agglutination tests, or abnormal gastrin-17 by ELISA and a subset of subjects with all normal biomarker values were referred for upper endoscopy with biopsies. Performance of biomarkers, corrected by verification bias, to detect five composite outcomes based on atrophy, intestinal metaplasia, dysplasia or cancer was explored. Results––Data from 1045 subjects were analysed, of those 273 with normal biomarker results. Both pepsinogen assays showed high specificity (>93%) but poor sensitivity (range: 18.4–31.1%) that slightly improved when lesions were restricted to corpus location (40.5%) but decreased when dysplasia and prevalent cancer cases were included (23.8%). Adding gastrin-17 detection, sensitivity reached 33–45% while specificity decreased (range: 61.1–62%) and referral rate for upper endoscopy increased to 38.6%. Conclusions––Low sensitivity of pepsinogen assays is a limiting factor for their use in population-based primary gastric cancer screening, however their high specificity could be useful for triage.
KW - gastric cancer prevention
KW - gastrin-17
KW - public health
KW - screening
KW - serum pepsinogens
UR - http://www.scopus.com/inward/record.url?scp=85137376630&partnerID=8YFLogxK
U2 - 10.3390/diagnostics12071746
DO - 10.3390/diagnostics12071746
M3 - Article
AN - SCOPUS:85137376630
SN - 2075-4418
VL - 12
SP - 1
EP - 11
JO - Diagnostics
JF - Diagnostics
IS - 7
M1 - 1746
ER -