Validity of serum pepsinogen I/II ratio for the diagnosis of gastric epithelial dysplasia and intestinal metaplasia during the follow-up of patients at risk for intestinal-type gastric adenocarcinoma

Neoplasia. Sep-Oct 2004;6(5):449-56. doi: 10.1593/neo.03505.

Abstract

A cohort of individuals (n = 136) with lesions as severe as atrophic chronic gastritis (ACG) was cross-sectionally evaluated for the validity assessment of pepsinogen I (PGI) and pepsinogen II (PGII) serum levels for the diagnosis of intestinal metaplasia (IM) and gastric dysplasia. PGI/PGII ratio [median (range)] was 4 (0.5-7.5) in patients with ACG (n = 35); 4.6 (1.9-6.8) in type I IM (n = 18); 4.2 (1.4-5.9) in type II or type III IM limited to the antrum and incisura (n = 20); 2.4 (0.4-5.6) in extensive incomplete IM (n = 38); and 1.3 (0.4-6.4) in low-grade dysplasia (n = 23) (P = .002). Using histopathologic data as a reference test, the area under the receiver operating characteristic curves (CI 95%) was 0.73 (0.64-0.82) for extensive IM, 0.72 (0.58-0.85) for the diagnosis of dysplasia, and 0.81 (0.66-0.95) for the diagnosis of high-grade dysplasia. Using a PGI/PGII ratio of < or =3 as the cutoff for dysplasia diagnosis, the sensitivity was 70% (62-78%), the specificity was 65% (57-73%), and the negative predictive value estimates were over 90%. No differences in PG levels according to age or gender were observed. Helicobacter pylori did not significantly influence validity measurement estimates. PGI/PGII serum level ratio can be used even in the management of patients with a high a priori probability for a positive test. It may be useful for the exclusion of more advanced lesions (extensive IM and neoplastic lesions).

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenocarcinoma / diagnosis*
  • Adult
  • Aged
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Gastric Mucosa / pathology
  • Gastritis, Atrophic / diagnosis*
  • Gastritis, Atrophic / microbiology
  • Gastritis, Atrophic / pathology
  • Helicobacter pylori / isolation & purification
  • Humans
  • Intestinal Mucosa / pathology
  • Male
  • Metaplasia / pathology
  • Middle Aged
  • Pepsinogen A / blood*
  • Pepsinogen C / blood*
  • Precancerous Conditions / diagnosis*
  • Risk Assessment
  • Stomach Neoplasms / diagnosis*

Substances

  • Pepsinogen C
  • Pepsinogen A