Diagnostic Value of Pepsinogen I and II for Pre-cancerous Gastric Lesions in Dyspeptic Patients

Abdol Rahim Masjedizadeh, Eskandar Hajiani, Pezhman Alavinejad, Jalal Hashemi, Ali Akbar Shayesteh, Tahminah Zarkami


AIM: Determining the diagnostic value of pepsinogen I and II as a noninvasive way for evaluation of precancerous gastric atrophy in comparison with endoscopic biopsy. METHODS: Five specimens obtained by upper endoscopy of above 40-year-old dyspeptic patients were evaluated by updated Sydney classification. Intestinal metaplasia and any type of dysplasia were interpreted as a premalignant lesion. Serum pepsinogen I and II levels were measured and their diagnostic efficacy indices for precancerous lesions were determined. RESULTS: Overall, 176 patients (92 men; mean age, 53.97±10.25) participated. Pepsinogen I and II levels were lowest in corpus involvement (P=0.0001). With the progression of gastritis, the mean level of pepsinogen I decreased, but the decrease in pepsinogen II and pepsinogen I/II ratio were meaningful in dysplasia and in different pathologic situations (P=0.0001). For the detection of premalignant lesions, the sensitivity, specificity, positive and negative predictive values of pepsinogen I<70 ng/mL were 58%, 82%, 78% and 64%, respectively while for pepsinogen II<7.5 ng/mL, they were 45%, 65%, 58% and 52%. These values for pepsinogen I/II<3 were 32%, 95%, 38% and 57%, respectively. In case of positive results of all the three mentioned items, the values were 15%, 97.6%, 87.5% and 52%, respectively. CONCLUSION: The low sensitivity limits the ability of these biomarkers for screening of premalignant lesions, but they could have a role as one of the first steps in the evaluation of high risk gastric cancer patients.

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