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Logo of bmcgastBioMed Centralsearchsubmit a manuscriptregisterthis articleBMC Gastroenterology
BMC Gastroenterol. 2012; 12: 86.
Published online Jul 9, 2012. doi:  10.1186/1471-230X-12-86
PMCID: PMC3438089
Ferritin above 100 mcg/L could rule out colon cancer, but not gastric or rectal cancer in patients with involuntary weight loss
Cristian Baicus,corresponding author1,3,5 Simona Caraiola,1,3,5 Mihai Rimbas,2,3,5 Ruxandra Patrascu,1,5 and Anda Baicus3,4,5, for the GSSPI
1Department of Internal Medicine, Colentina University Hospital, Soseaua Stefan cel Mare 19-21, sector 2, Bucharest, 020125, Romania
2Department of Gastroenterology, Colentina University Hospital, Soseaua Stefan cel Mare 19-21, sector 2, Bucharest, 020125, Romania
3Clinical Research Unit RECIF (Réseau d’ Epidémiologie Clinique International Francophone), Bucharest, Romania
4I. Cantacuzino” National Institute of Research and Development in Microbiology-Immunology, Splaiul Independentei 103, sector 5, Bucharest, 050096, Romania
5University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
corresponding authorCorresponding author.
Cristian Baicus: cbaicus/at/; Simona Caraiola: scaraiola/at/; Mihai Rimbas: mrimbas/at/; Ruxandra Patrascu: ruxandrapatrascu/at/; Anda Baicus: abaicus/at/
Received December 7, 2011; Accepted June 28, 2012.
A tenth of patients with involuntary weight loss (IWL) have gastrointestinal cancer. Ferritin is the first parameter to be modified during the process leading to iron deficiency anaemia, therefore it should be the most sensitive. The aim of this study was to assess the ability of ferritin to rule out gastrointestinal cancer in patients with involuntary weight loss.
All consecutive patients with IWL admitted in a secondary care university hospital were prospectively studied. Ferritin, haemoglobin with erythrocyte indices and serum iron were recorded for all patients. The reference standard was bidirectional endoscopy and/or 6 months follow-up.
290 patients were included, a quarter had cancer, of which 22 (7.6%) had gastrointestinal cancer (8 gastric cancer, 1 ileum cancer, 13 colorectal cancer). Ferritin had the best area under the curve (AUC), both for gastrointestinal cancer (0.746, CI: 0.691-0.794), and colorectal cancer (0.765, CI: 0.713-0.813), compared to the other parameters of iron deficiency. In the diagnosis of colorectal cancer, ferritin with a cut-off value of 100 mcg/L had a sensitivity of 93% (CI: 69-100%), and negative likelihood ratio of 0.13, with a negative predictive value of 99% (96-100%), while for gastrointestinal cancer, the sensitivity was lower (89%, CI: 67-95%), with a negative likelihood ratio of 0.24. There were three false negative patients, two with gastric cancer, and one with rectal cancer.
In patients with involuntary weight loss, a ferritin above 100mcg/L could rule out colon cancer, but not gastric or rectal cancer.
Keywords: Area under the curve (AUC), Gastrointestinal cancer, Colon cancer, Ferritin, Involuntary weight loss, Sensitivity and specificity
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