Altomare D F, Picciariello A, Rotelli M T, De Fazio M, Aresta A, Zambonin C G, Vincenti L, Trerotoli P, De Vietro N
Surgical Unit 'M. Rubino', Department of Emergency and Organ Transplantation, Bari, Italy.
Apulian Breath Analysis Centre (CeRBA), Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Tumori Giovanni Paolo II, Bari, Italy.
BJS Open. 2020 Sep 29;4(6):1189-99. doi: 10.1002/bjs5.50354.
Effective screening for colorectal cancer can reduce mortality by early detection of tumours and colonic polyps. An altered pattern of volatile organic compounds (VOCs) in exhaled breath has been proposed as a potential non-invasive diagnostic tool for detection of cancer. The aim of this study was to evaluate the reliability of breath-testing for colorectal cancer screening and early diagnosis using an advanced breath sampler.
The exhaled breath of patients with colorectal cancer and non-cancer controls with negative findings on colonoscopy was collected using the ReCIVA® Breath Sampler. This portable device is able to capture the alveolar breath fraction without environmental contamination. VOCs were desorbed thermally and analysed by gas chromatography-mass spectrometry. The discriminatory ability of VOCs in detecting colorectal cancer was evaluated by receiver operating characteristic (ROC) curve analysis for each VOC, followed by cross-validation by the leave-one-out method, and by applying stepwise logistic regression analysis.
The study included 83 patients with colorectal cancer and 90 non-cancer controls. Fourteen VOCs were found to have significant discriminatory ability in detecting patients with colorectal cancer. The model with the diagnosis of cancer versus no cancer resulted in a statistically significant likelihood of discrimination of 173·45 (P < 0·001), with an area under the ROC curve of 0·979. Cross-validation of the model resulted in a true predictive value for colorectal cancer of 93 per cent overall. Reliability of the breath analysis was maintained irrespective of cancer stage.
This study demonstrated that analysis of exhaled VOCs can discriminate patients with colorectal cancer from those without. This finding may eventually lead to the creation of a smart online sensory device, capable of providing a binary answer (cancer/no cancer) and directing to further screening.
有效的结直肠癌筛查可通过早期发现肿瘤和结肠息肉降低死亡率。呼出气体中挥发性有机化合物（VOCs）模式的改变已被提议作为一种潜在的癌症非侵入性诊断工具。本研究的目的是使用先进的呼气采样器评估呼气测试用于结直肠癌筛查和早期诊断的可靠性。
使用ReCIVA®呼气采样器收集结直肠癌患者和结肠镜检查结果为阴性的非癌症对照者的呼出气体。这种便携式设备能够采集肺泡呼气部分而不受环境污染。VOCs通过热解吸并采用气相色谱 - 质谱法进行分析。通过对每种VOC进行受试者操作特征（ROC）曲线分析评估VOCs在检测结直肠癌方面的鉴别能力，随后采用留一法进行交叉验证，并应用逐步逻辑回归分析。
该研究纳入了83例结直肠癌患者和90例非癌症对照者。发现14种VOCs在检测结直肠癌患者方面具有显著的鉴别能力。癌症诊断与非癌症诊断的模型产生了具有统计学意义的鉴别可能性173.45（P < 0.001），ROC曲线下面积为0.979。该模型的交叉验证得出结直肠癌的总体真实预测值为93%。无论癌症分期如何，呼气分析的可靠性均得以维持。
本研究表明，呼出VOCs分析能够区分结直肠癌患者和非患者。这一发现最终可能促成一种智能在线传感设备的诞生，该设备能够提供二元答案（癌症/非癌症）并指导进一步筛查。
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