Boulind Caroline E, Gould Oliver, de Lacy Costello Ben, Allison Joanna, White Paul, Ewings Paul, Wicaksono Alfian N, Curtis Nathan J, Pullyblank Anne, Jayne David, Covington James A, Ratcliffe Norman, Turner Claire, Francis Nader K
Department of General Surgery, Yeovil District Hospital NHS Foundation Trust, Higher Kingston, Yeovil BA21 4AT, UK.
Institute of Bio-Sensing Technology, Frenchay Campus, University of the West of England, Coldharbour Lane, Bristol BS16 1QY, UK.
Cancers (Basel). 2022 Apr 24;14(9):2127. doi: 10.3390/cancers14092127.
Colorectal symptoms are common but only infrequently represent serious pathology, including colorectal cancer (CRC). A large number of invasive tests are presently performed for reassurance. We investigated the feasibility of urinary volatile organic compound (VOC) testing as a potential triage tool in patients fast-tracked for assessment for possible CRC. A prospective, multi-center, observational feasibility study was performed across three sites. Patients referred to NHS fast-track pathways for potential CRC provided a urine sample that underwent Gas Chromatography-Mass Spectrometry (GC-MS), Field Asymmetric Ion Mobility Spectrometry (FAIMS), and Selected Ion Flow Tube Mass Spectrometry (SIFT-MS) analysis. Patients underwent colonoscopy and/or CT colonography and were grouped as either CRC, adenomatous polyp(s), or controls to explore the diagnostic accuracy of VOC output data supported by an artificial neural network (ANN) model. 558 patients participated with 23 (4%) CRC diagnosed. 59% of colonoscopies and 86% of CT colonographies showed no abnormalities. Urinary VOC testing was feasible, acceptable to patients, and applicable within the clinical fast track pathway. GC-MS showed the highest clinical utility for CRC and polyp detection vs. controls (sensitivity = 0.878, specificity = 0.882, AUROC = 0.896) but it is labour intensive. Urinary VOC testing and analysis are feasible within NHS fast-track CRC pathways. Clinically meaningful differences between patients with cancer, polyps, or no pathology were identified suggesting VOC analysis may have future utility as a triage tool.
结直肠症状很常见，但很少代表严重病变，包括结直肠癌（CRC）。目前进行了大量侵入性检查以消除疑虑。我们研究了尿挥发性有机化合物（VOC）检测作为快速评估可能患有CRC患者的潜在分诊工具的可行性。在三个地点进行了一项前瞻性、多中心、观察性可行性研究。被转诊至NHS快速通道评估潜在CRC的患者提供了一份尿液样本，该样本接受了气相色谱 - 质谱联用（GC - MS）、场不对称离子迁移谱（FAIMS）和选择离子流管质谱（SIFT - MS）分析。患者接受了结肠镜检查和/或CT结肠成像，并被分为CRC组、腺瘤性息肉组或对照组，以探索由人工神经网络（ANN）模型支持的VOC输出数据的诊断准确性。558名患者参与，其中23例（4%）被诊断为CRC。59%的结肠镜检查和86%的CT结肠成像未显示异常。尿VOC检测是可行的，患者可接受，且适用于临床快速通道。与对照组相比，GC - MS在CRC和息肉检测方面显示出最高的临床效用（敏感性 = 0.878，特异性 = 0.882，曲线下面积 = 0.896），但劳动强度大。尿VOC检测和分析在NHS快速通道CRC路径中是可行的。在患有癌症、息肉或无病变的患者之间发现了具有临床意义的差异，表明VOC分析可能作为一种分诊工具具有未来应用价值。
