Pancreatic ductal adenocarcinoma can be detected by analysis of volatile organic compounds (VOCs) in alveolar air

Abstract

BackgroundIn the last decade many studies showed that the exhaled breath of subjects suffering from several pathological conditions has a peculiar volatile organic compound (VOC) profile. The objective of the present work was to analyse the VOCs in alveolar air to build a diagnostic tool able to identify the presence of pancreatic ductal adenocarcinoma in patients with histologically confirmed disease.MethodsThe concentration of 92 compounds was measured in the end-tidal breath of 65 cases and 102 controls. VOCs were measured with an ion-molecule reaction mass spectrometry. To distinguish between subjects with pancreatic adenocarcinomas and controls, an iterated Least Absolute Shrinkage and Selection Operator multivariate Logistic Regression model was elaborated.ResultsThe final predictive model, based on 10 VOCs, significantly and independently associated with the outcome had a sensitivity and specificity of 100 and 84% respectively, and an area under the ROC curve of 0.99. For further validation, the model was run on 50 other subjects: 24 cases and 26 controls; 23 patients with histological diagnosis of pancreatic adenocarcinomas and 25 controls were correctly identified by the model.ConclusionsPancreatic cancer is able to alter the concentration of some molecules in the blood and hence of VOCs in the alveolar air in equilibrium. The detection and statistical rendering of alveolar VOC composition can be useful for the clinical diagnostic approach of pancreatic neoplasms with excellent sensitivity and specificity.Electronic supplementary materialThe online version of this article (10.1186/s12885-018-4452-0) contains supplementary material, which is available to authorized users.

Pancreatic cancer: A review of clinical diagnosis, epidemiology, treatment and outcomes

“…Other non-invasive alternatives to blood have been investigated as mediums for early detection biomarker research, namely the increased concentration of volatile organic compounds (VOC) in exhaled air specific. A recent case-control study found raised levels of VOC in patients with pancreatic cancer compared to healthy controls with a sensitivity and specificity of 100% and 84% respectively[ 85 ]. This is another avenue of potential further study in the development of a non-invasive biomarker for pancreatic cancer.…”

Discriminant Profiles of Volatile Compounds in the Alveolar Air of Patients with Squamous Cell Lung Cancer, Lung Adenocarcinoma or Colon Cancer

“…For exhaled breath sampling, subjects were asked to make one deep exhalation inside a hand-device called a Bio-VOC breath sampler ® (Markes International Ltd. Rhondda Cynon Taff. UK), which is a special 250 mL air syringe able to avoid any re-breath phase, as previously described [ 17 , 21 ]. Through the syringe, the breathed air flows into a 20 mL glass vial with a wide-bordered opening, formerly sterilized and kept at 80 °C for at least 24 h to avoid the presence of environmental pollutants.…”

“…An AirSense Compact analyzer and a V&F autosampler (V&F Analyse- und Messtechnik GmbH. Absam, Austria) were used for analyzing the volatile compounds present in the samples, as previously described [ 17 , 64 , 65 ]. The AirSense Compact analyzer consists of a conventional electron impact MS and a highly sensitive ion molecule reaction mass spectrometer (corresponding to chemical ionization mass spectrometry).…”

“…Breath samples contain hundreds of compounds that have been commonly measured by different authors in recent decades; many volatile compounds have been identified from the breath of patients with lung cancer, which is the most studied since 1985 [ 8 , 11 ], or breast cancer [ 12 ]. Increasingly popular research projects in the literature show that breath tests are useful in different pathological conditions, like esophageal and gastric adenocarcinomas [ 13 ], colorectal cancers [ 14 ], cervical cancers [ 15 ], ovarian cancers [ 16 ] and pancreas adenocarcinomas [ 17 , 18 ]. Additionally, chronic diseases, such as Crohn’s disease or ulcerative colitis [ 19 , 20 , 21 ], cystic fibrosis [ 22 ], chronic obstructive pulmonary diseases [ 23 ] and different infective diseases [ 24 ] show changes in the VOC pattern.…”

Breath Analysis: A Systematic Review of Volatile Organic Compounds (VOCs) in Diagnostic and Therapeutic Management of Pleural Mesothelioma

“…The strength is the ionization process offering the possibility to reduce fragmentation caused by high energy electron impact ionization. IMR-MS approach has been recently applied for VOCs detection in breath samples resulting, in combination with statistical treatments, in an improved diagnostic accuracy of breath analysis for the detection of pancreatic ductal adenocarcinoma [74] and liver diseases such as alcoholic fatty liver disease (AFLD) and non-AFLD (NAFLD) and cirrhosis [75,76].…”