Early screening and risk factors for gastric cancer

Table 1 Comparison of gastric cancer screening methods

Screening methods	Sensitivity	Specificity	Advantages	Limitations
Tumor markers
CA724	33.0%	94.0%	Simple to detect and noninvasive, suitable for monitoring therapeutic efficacy and prognostic assessments	Low sensitivity and specificity, high false-positive rate, not suitable for early screening
CEA	25.5%	97.9%
CA125	31.1%	97.3%
CA199	38.7%	92.6%
Gastric function biomarkers
PG	57%-59%	73%-87%	Noninvasive, convenient, low-cost	Sensitivity and specificity are limited due to interference from benign gastric conditions
G-17	70%	93%
GastroPanel	51%-59%	61%-66%	Noninvasive and convenient; aids in diagnosing gastric mucosal diseases	Low sensitivity and specificity; threshold optimization requires a consideration of baseline population characteristics
Liquid biopsy
CTCs	85.3%	90.3%	High tumor specificity; noninvasive; aids in early diagnosis and prognostic assessments	Enrichment and identification techniques lack uniform standards; low blood levels; prone to interference from epithelial-mesenchymal transition processes or benign inflammation
CtDNA	51.5%	99.5%	Noninvasive with high patient compliance; predicts postoperative recurrence	Low sensitivity; lack of standardized operating procedures
DNA methylation	56%-63%	91%-100%	Noninvasive; high specificity; combined testing increases detection efficacy	Testing techniques need standardization; testing costs remain relatively high; multicenter studies are needed for validation
MiRNA	87.0%	68.4%	Good serum stability, high diagnostic accuracy	Research heterogeneity and inconsistent results; high costs
LncRNAs	80%	70%	Predict tumor invasion/metastasis/prognosis; their combination with protein markers increases diagnostic efficacy	The specificity of standalone testing is limited, and further research is needed to validate their clinical utility
CircRNAs	78%	84%	Noninvasive; high stability; early diagnosis	Detection technology requires standardization; clinical implementation data are insufficient
Imaging examinations
Gastric ultrasound	60.8%-88.7%	83.5%-91%	Noninvasive, radiation-free; clearly displays gastric wall layers, supplements T staging	EGC detection has low sensitivity; it is significantly affected by gastric gas and operator technique; biopsy is not feasible
Upper gastrointestinal series	36.7%	96.1%	Dynamic observation of gastrointestinal motility; relatively simple to operate	Radioactive, biopsy cannot be performed; low sensitivity; high false-negative rate
CT	77.1%-88.9%	80.0%-96.8%	Assesses the depth of invasion and metastasis	Limited sensitivity in detecting EGC; radiation exposure; requires large-scale prospective validation
MRI	71.4%-82.6%	91.4%-100%	High soft tissue resolution with no radiation exposure; diffusion-weighted imaging demonstrates high accuracy in detecting lymph node metastasis	The examination is time-consuming, with insufficient sensitivity for detecting early mucosal lesions; biopsy is not feasible
Endoscopic examinations
EUS	50%-90%	NA	Accurately determines the depth of invasion and peri-gastric lymph nodes; guides endoscopic resection	High technical demands and time-consuming; biopsy is not feasible; low accuracy in T2 lesion assessments
MCCE	92%	90%	Noninvasive, no anesthesia needed; excellent tolerability; capable of detecting lesions missed by gastroscopy	Unsuitable for biopsy/treatment; difficult to control through the pylorus; relies on gastrointestinal motility
EGD	74.6%	94.0%	Intuitive visualization and precise localization; high diagnostic accuracy; biopsy confirmation	Invasive, low compliance; potential risk of complications; high cost

CA: Carbohydrate antigens; CEA: Carcinoembryonic antigen; PG: Pepsinogen; G-17: Gastrin-17; CTC: Circulating tumor cell; ctDNA: Circulating tumor DNA; miRNA: MicroRNA; lncRNA: Long noncoding RNA; circRNA: Circular RNA; CT: Computed tomography; MRI: Magnetic resonance imaging; EUS: Endoscopic ultrasonography; MCCE: Magnetically controlled capsule endoscopy; EGD: Esophagogastroduodenoscopy; EGC: Early gastric cancer; NA: Not available.