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.
Highlights
In 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
Patients involved in this study were planned for the surgical intervention and alveolar air samples were collected 1-3 days before surgery in order to avoid any interference with VOCs in alveolar air related to drugs used in the operating room or to the stress related of surgical intervention
We found no significant difference in terms of sex distribution between controls and the outcome group
Summary
In 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. In 1985 for the first time the possibility of identifying the presence of lung cancer through the examination of exhaled air [4] was pointed out. In subsequent phases Phillips et al [5] made an analogous research using less complex equipment and confirmed the possibility of recognizing the presence of lung neoplasms using alveolar air. The same team published some results concerning patients with breast cancer [7]. They broadened and deepened the analysis on lung neoplasms [8]. Every important biological variation of the organism should come with significant biochemical changes and with interferences to the functionality of the immune defence system
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