Abstract
BackgroundLung cancer is the most common oncological cause of death in the Western world. Early diagnosis is critical for successful treatment. However, no effective screening methods exist. A promising approach could be the use of volatile organic compounds as diagnostic biomarkers. To date there are several studies, in which dogs were trained to discriminate cancer samples from controls. In this study we evaluated the abilities of specifically trained dogs to distinguish samples derived from lung cancer patients of various tumor stages from matched healthy controls.MethodsThis single center, double-blind clinical trial was approved by the local ethics committee, project no FF20/2016. The dog was conditioned with urine and breath samples of 36 cancer patients and 150 controls; afterwards, further 246 patients were included: 41 lung cancer patients comprising all stages and 205 healthy controls. From each patient two breath and urine samples were collected and shock frozen. Only samples from new subjects were presented to the dog during study phase randomized, double-blinded. This resulted in a specific conditioned reaction pointing to the cancer sample.ResultsUsing a combination of urine and breath samples, the dog correctly predicted 40 out of 41 cancer samples, corresponding to an overall detection rate of cancer samples of 97.6% (95% CI [87.1, 99.9%]). Using urine samples only the dog achieved a detection rate of 87.8% (95% CI [73.8, 95.9%]). With breath samples, the dog correctly identified cancer in 32 of 41 samples, resulting in a detection rate of 78% (95% CI [62.4, 89.4%]).ConclusionsIt is known from current literature that breath and urine samples carry VOCs pointing to cancer growth. We conclude that olfactory detection of lung cancer by specifically trained dogs is highly suggestive to be a simple and non-invasive tool to detect lung cancer. To translate this approach into practice further target compounds need to be identified.
Highlights
Lung cancer is the most common oncological cause of death in the Western world
Patients were separated into 2 groups: Cancer patients were defined as patients with histologically proven lung cancer, and controls were defined as participants with no detectable tumor and a physiological heart and lung auscultation
For the main outcome the detection rate was computed as the proportion of correctly identified cancer samples, this was compared to 78% using one-sided exact binomial tests, since 78% was the mean values for sensitivity to the literature [9,10,11, 14, 15] and the proportion of correctly identified cancer samples is approximately equal to the sensitivity
Summary
Lung cancer is the most common oncological cause of death in the Western world. To date there are several studies, in which dogs were trained to discriminate cancer samples from controls. In this study we evaluated the abilities of trained dogs to distinguish samples derived from lung cancer patients of various tumor stages from matched healthy controls. Lung cancer: mortality, risk, and screening methods Lung cancer is the leading oncological cause of death in western countries and it is the second most frequent cause of death after cardiovascular diseases in Germany [1]. The prognosis of lung cancer is unfavorable as indicated by the death of 16.382 female and 29.692 male patients in Germany 2017 [1]. An advanced age at diagnosis is considered as unfavorable prognostic factor [3]. In 2017 the median age of death was years for women and years for men [1]
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