Abstract
BackgroundImproving the ability to identify early-stage head and neck squamous cell carcinoma (HNSCC) can improve treatment outcomes and patient morbidity. We sought to determine the diagnostic accuracy of breath analysis as a non-invasive test for detecting HNSCC.MethodsStandardised breath samples were collected from 181 patients suspected of HNSCC prior to any treatment. A selected ion flow-tube mass spectrometer was used to analyse breath for volatile organic compounds. Diagnosis was confirmed by histopathology. A binomial logistic regression model was used to differentiate breath profiles between cancer and control (benign disease) patients based on mass spectrometry derived variables.ResultsIn all, 66% of participants had early-stage primary tumours (T1 and T2) and 58% had regional node metastasis. The optimised logistic regression model using three variables had a sensitivity and specificity of 80% and 86%, respectively, with an AUC for ROC curve of 0.821 (95%CI 0.625–1.0) in the testing cohort.ConclusionsBreath analysis for non-invasive diagnosis of HNSCC appears to be practical and accurate. Future studies should be conducted in a primary care setting to determine the applicability of breath analysis for early identification of HNSCC.
Highlights
Improving the ability to identify early-stage head and neck squamous cell carcinoma (HNSCC) can improve treatment outcomes and patient morbidity
A control group consisted of healthy adult patients who presented for pan-endoscopy with upper aerodigestive symptoms and clinical suspicion of HNSCC, but subsequently had a normal pan-endoscopy examination or histologically benign biopsy results
Patients with suspected head and neck cancer often present to a primary care setting with non-specific upper aerodigestive symptoms; complete examination by the general practitioner is restricted by technical limitations
Summary
Improving the ability to identify early-stage head and neck squamous cell carcinoma (HNSCC) can improve treatment outcomes and patient morbidity. We sought to determine the diagnostic accuracy of breath analysis as a non-invasive test for detecting HNSCC. More recently, a surge in human papilloma virus (HPV)-associated oropharyngeal cancers have been reported in the US,[1] Canada[2] and UK.[3] These cancers are affecting a much younger population without classical risk factors for HNSCC.[4] Worldwide, HNSCC accounts for 6% of all cancers and up to 2% of cancer-related deaths.[5] Current therapies are effective at treating early-stage disease, with limited morbidity; late-stage presentations are common, and often associated with poor prognosis and high treatment-related morbidity.[6] methods of early detection are needed to improve the treatment outcomes of HNSCC patients
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