title: Ferritin above 100 mcg/L could rule out colon cancer, but not gastric or rectal cancer in patients with involuntary weight loss.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  In patients with involuntary weight loss, a ferritin above 100mcg/L could rule out colon cancer, but not gastric or rectal cancer.
authors: Department of Internal Medicine, Colentina University Hospital, Soseaua Stefan cel Mare 19-21, sector 2, Bucharest, 020125, Romania. cbaicus@clicknet.ro
authors: Cristian
authors: C
authors: Baicus
authors: Simona
authors: S
authors: Caraiola
authors: Mihai
authors: M
authors: Rimbas
authors: Ruxandra
authors: R
authors: Patrascu
authors: Anda
authors: A
authors: Baicus
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D003110:Colonic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D004909:Erythrocyte Indices; D005260:Female; D005293:Ferritins / Q000097:blood*; D005500:Follow-Up Studies; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D015431:Weight Loss / Q000502:physiology
chemical_list: D015415:Biomarkers; D006454:Hemoglobins; D005293:Ferritins