Risk stratification in gastric cancer screening: Measures against the pseudo-A group based on additional criteria (The second report)

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  • 胃がんリスク診断;追加基準による偽Ａ群対策(第二報)
  • 胃がんリスク診断 : 追加基準による偽A群対策(第2報)
  • イガン リスク シンダン : ツイカ キジュン ニ ヨル ニセ Aグン タイサク(ダイ2ホウ)

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As a measure against the pseudo-A group in gastric cancer risk diagnosis during population-based screening, we established additional criteria: pepsinogen (PG)-1, ≤ 35 ng/mL; PG-2, ≥15 ng/mL; Helicobacter pylori antibody titer, ≥5 to ≤10 U/mL; and history of H. pylori eradication. Even when the results based on the conventional criteria were judged to be A, if positive results were obtained based on at least one of the additional criteria, we recommended detailed endoscopy. In 2013, 40.9% (4,052/9,916) of patients who were categorized into the A group based on the conventional criteria were diagnosed as positive when the evaluation was based on the additional criteria. Atrophic gastritis was detected in 46.4% (337/726) of patients. Many of them showed pseudo-positive results, thereby necessitating improvements in screening. In 2015, the following modifications to the additional criteria were made: low PG-1 values and high PG-2 values were to be applied to persons ≥60 years old; and abnormal antibody titer range was to be broadened to ≥3 to <10 U/mL. As a result, in 2015, 32.2% (1,218/3,782) of patients who had been categorized into the A group based on the conventional criteria were diagnosed as positive when the evaluation was based on the new additional criteria. Atrophic gastritis was detected in 69.1% (401/580) of patients. Thus, the number of unnecessary detailed examinations was reduced. We conducted a questionnaire-based survey to investigate to what extent follow-up observations were made after the detailed endoscopy was performed in 2013. The results of the B, C, and D groups revealed that the first follow-up endoscopy was performed in 41.2% of patients at a mean of 1.47 years after the detailed endoscopy, and that the second follow-up endoscopy was performed in 19.6% of patients at a mean of 1.06 years after the first follow-up endoscopy. The results of this survey in the high-risk groups show that there are still problems that need to be addressed.

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