| [ Summary ] |
We described an effective combination of serum pepsinogen test and photofluorography for gastric cancer screening. When using a serum pepsinogen test for gastric cancer screening, the double contrast method, using high density barium, is the most suitable for combination with a serum pepsinogen test. This combination method will reduce false negative cases in not only the diffuse type of advanced gastric cancer but, also in the diffuse type of early gastric cancer, especially submucosal cancer and depressed type cancer with ulceration, compared to results obtained when using a serum pepsinogen test only. Serum pepsinogen test has three diagnostic criteria. The cut off points for gastric cancer screening, as well as photofluorography follow three diagnostic levels (+-suspicious, +probable, ++certain). Generally, the most suitable cut off point is a pepsinogen I concentration of less than 50 ng/ml and a ratio of pepsinogen I to pepsinogen II of less than 3.0 in the combination method. It is necessary to decide when cases are judged to be level+ or ++ by radiologists and patients, need further examinations in the region of gastric body. However, in other regions of the stomach, all cases judged to be level+- or + or ++ need further examination. This combination method is excellent in terms of sensitivity and specificity for gastric cancer screening. Furthermore, we can choose the most suitable combination of serum pepsinogen test and photofluorography for gastric cancer screening for each case by selecting individual cut off points for serum pepsinogen test and the diagnostic criteria for photofluorography. |