title: A new NMR-based metabolomics approach for the diagnosis of biliary tract cancer.
abstract: OBJECTIVE
  Biliary tract cancer is highly lethal at presentation, with increasing mortality worldwide. Current diagnostic measures employing multiple criteria such as imaging, cytology, and serum tumor markers are not satisfactory, and a new diagnostic tool is needed. Because bile is a cognate metabolite-rich bio-fluid in the biliary ductal system, we tested a new metabolomic approach to develop an effective diagnostic tool.
  
  
  METHODS
  Biles were collected prospectively from patients with cancer (n=17) or benign biliary tract diseases (n=21) with percutaneous or endoscopic methods. Nuclear magnetic resonance spectra (NMR) of these biles were analyzed using orthogonal partial least square discriminant analysis (OPLS-DA).
  
  
  RESULTS
  The metabolomic 2-D score plot showed good separation between cancer and benign groups. The contributing NMR signals were analyzed using a statistical TOCSY approach. The diagnostic performance assessed by leave-one-out analysis exhibited 88% sensitivity and 81% specificity, better than the conventional markers (CEA, CA19-9, and bile cytology).
  
  
  CONCLUSIONS
  The NMR-based metabolomics approach provides good performance in discriminating cancer and benign biliary duct diseases. The excellent predictability of the method suggests that it can, at least, augment the currently available diagnostic approaches.
authors.affiliation: Department of Biochemistry, Inha University Hospital and Center for Advanced Medical Education by BK21 Project, College of Medicine, Inha University, Incheon, Republic of Korea.
authors.forename: He
authors.initials: H
authors.lastname: Wen
authors.forename: Sung Soo
authors.initials: SS
authors.lastname: Yoo
authors.forename: Jinho
authors.initials: J
authors.lastname: Kang
authors.forename: Hee Goo
authors.initials: HG
authors.lastname: Kim
authors.forename: Jin-Seok
authors.initials: JS
authors.lastname: Park
authors.forename: Seok
authors.initials: S
authors.lastname: Jeong
authors.forename: Jung Il
authors.initials: JI
authors.lastname: Lee
authors.forename: Hyuk Nam
authors.initials: HN
authors.lastname: Kwon
authors.forename: Sunmi
authors.initials: S
authors.lastname: Kang
authors.forename: Don-Haeng
authors.initials: DH
authors.lastname: Lee
authors.forename: Sunghyouk
authors.initials: S
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001646:Bile / Q000378:metabolism*; D001660:Biliary Tract Diseases / Q000175:diagnosis / Q000378:metabolism; D001661:Biliary Tract Neoplasms / Q000175:diagnosis* / Q000378:metabolism*; D005260:Female; D006801:Humans; D016018:Least-Squares Analysis; D009682:Magnetic Resonance Spectroscopy / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D055432:Metabolomics / Q000379:methods* / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies