Urinary Volatile Organic Compound Testing in Fast-Track Patients with Suspected Colorectal Cancer.
Urinary Volatile Organic Compound Testing in Fast-Track Patients with Suspected Colorectal Cancer.
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目前可能的结直肠癌的调查途径包括使用结肠镜检查。这是一种侵入性和令人不快的手术，目前，大量的手术是正常的。先前的研究表明，尿液中的挥发性有机化合物（VOCs）可用于检测癌症，包括结直肠癌。然而，这些研究仅在已知患有癌症的患者中进行。本研究旨在评估尿液VOC分析在NHS两周等待癌症途径中的作用。在标准NHS评估途径期间，使用三种分析技术分析了558例患者的尿液样本。这表明，气相色谱-质谱（GCMS）具有良好的灵敏度和特异性，用于识别癌症和息肉在这一患者群体。这些结果显示了尿液VOC分析在NHS癌症筛查途径中的潜在作用，以减少对侵入性结肠镜检查的需求。结直肠症状是常见的，但只是偶尔代表严重的病理，包括结直肠癌（CRC）。目前进行了大量的侵入性测试以确保安全。我们研究了尿挥发性有机化合物（VOC）检测作为快速追踪评估可能的CRC患者的潜在分诊工具的可行性。在三个研究中心进行了一项前瞻性、多中心、观察性可行性研究。转诊至NHS快速通道途径的潜在CRC患者提供了一份尿样，该尿样接受了气相色谱-质谱法（GC-MS）、场不对称离子迁移谱法（FAIMS）和选择离子流管质谱法（SIFT-MS）分析。患者接受结肠镜检查和/或CT结肠造影，并被分组为CRC、腺瘤性息肉或对照，以探索人工神经网络（ANN）模型支持的VOC输出数据的诊断准确性。558例患者参与了研究，其中23例（4%）诊断为CRC。59%的结肠镜检查和86%的CT结肠造影显示无异常。尿液VOC检测是可行的，患者可接受的，适用于临床快速通道路径。与对照相比，GC-MS显示出CRC和息肉检测的最高临床效用（灵敏度= 0.878，特异性= 0.882，AUROC = 0.896），但其是劳动密集型的。尿液VOC测试和分析在NHS快速通道CRC途径中是可行的。在患有癌症、息肉或无病理的患者之间确定了具有临床意义的差异，这表明VOC分析可能具有未来作为分诊工具的实用性。
The current pathway for the investigation of possible colorectal cancer includes the use of colonoscopy. This is an invasive and unpleasant procedure, and currently, a large number of those performed are normal. Previous research has demonstrated that urinary volatile organic compounds (VOCs) can be used to detect cancer, including colorectal cancer. However, these studies have only taken place in patients already known to have cancer. This study aimed to assess the role of urinary VOC analysis in the NHS two weeks wait for cancer pathway. Three analytical techniques were used to analyze urine samples of 558 patients during the standard NHS assessment pathway. It demonstrated that gas chromatography-mass spectrometry (GCMS) has excellent sensitivity and specificity for the identification of cancer and polyps in this patient group. These results show a potential role for urinary VOC analysis in the NHS cancer screening pathway, to reduce the need for invasive colonoscopy testing. 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.
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影响因子：
3.3
作者：
Francis, N. K.;Luther, A.;Ockrim, J. B.
通讯作者：
Ockrim, J. B.
影响因子：
24.5
作者：
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English Bowel Cancer Screening Evaluation Committee
影响因子：
7.4
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Huang, Juzheng;Kumar, Sacheen;Hanna, George B.
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Hanna, George B.
影响因子：
105.7
作者：
Malila, Nea;Oivanen, Tiina;Hakama, Matti
通讯作者：
Hakama, Matti
影响因子：
3.7
作者：
Arasaradnam RP;Westenbrink E;McFarlane MJ;Harbord R;Chambers S;O'Connell N;Bailey C;Nwokolo CU;Bardhan KD;Savage R;Covington JA
通讯作者：
Covington JA