title: Volatile organic compounds in bile can diagnose malignant biliary strictures in the setting of pancreatic cancer: a preliminary observation.
abstract: BACKGROUND
  Ascertaining the nature of biliary strictures is challenging. The role of volatile organic compounds (VOCs) in bile in determining the cause of biliary strictures is not known.
  
  
  OBJECTIVE
  To identify potential VOCs in the headspaces (gas above the sample) of bile in patients with malignant biliary strictures from pancreatic cancer.
  
  
  METHODS
  Prospective cross-sectional study.
  
  
  METHODS
  Referral center.
  
  
  METHODS
  Prospective study in which bile was aspirated in 96 patients undergoing ERCP for benign and malignant conditions.
  
  
  METHODS
  Selected ion flow tube mass spectrometry (VOICE200R SIFT-MS instrument; Syft Technologies Ltd, Christchurch, New Zealand) was used to analyze the headspace and to build a predictive model for pancreatic cancer.
  
  
  RESULTS
  The headspaces from 96 bile samples were analyzed, including 24 from patients with pancreatic cancer and 72 from patients with benign biliary conditions. The concentrations of 6 compounds (acetaldehyde, acetone, benzene, carbon disulfide, pentane, and trimethylamine [TMA]) were increased in patients with pancreatic cancer compared with controls (P < .05). By using receiver-operating characteristic curve analysis, we developed a model for the diagnosis of pancreatic cancer based on the levels of TMA, acetone, isoprene, dimethyl sulfide, and acetaldehyde. The model [10.94 + 1.8229* log (acetaldehyde) + 0.7600* log (acetone) - 1.1746* log (dimethyl sulfide) + 1.0901* log (isoprene) - 2.1401 * log (trimethylamine) ≥ 10] identified the patients with pancreatic cancer (area under the curve = 0.85), with 83.3% sensitivity and 81.9% specificity.
  
  
  CONCLUSIONS
  Sample size.
  
  
  CONCLUSIONS
  The measurement of biliary fluid VOCs may help to distinguish malignant from benign biliary strictures. Further studies are warranted to validate these observations. (Clinical Trial Registration Number NCT01565460.).
authors.affiliation: Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland, Ohio, USA.
authors.forename: Udayakumar
authors.initials: U
authors.lastname: Navaneethan
authors.affiliation: Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland, Ohio, USA.
authors.forename: Mansour A
authors.initials: MA
authors.lastname: Parsi
authors.affiliation: Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland, Ohio, USA.
authors.forename: Norma G
authors.initials: NG
authors.lastname: Gutierrez
authors.affiliation: Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland, Ohio, USA.
authors.forename: Amit
authors.initials: A
authors.lastname: Bhatt
authors.affiliation: Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland, Ohio, USA.
authors.forename: Preethi G K
authors.initials: PG
authors.lastname: Venkatesh
authors.affiliation: Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland, Ohio, USA.
authors.forename: Dennisdhilak
authors.initials: D
authors.lastname: Lourdusamy
authors.affiliation: Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: David
authors.initials: D
authors.lastname: Grove
authors.affiliation: Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland, Ohio, USA.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Hammel
authors.affiliation: Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland, Ohio, USA.
authors.forename: Sunguk
authors.initials: S
authors.lastname: Jang
authors.affiliation: Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland, Ohio, USA.
authors.forename: Madhusudhan R
authors.initials: MR
authors.lastname: Sanaka
authors.affiliation: Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland, Ohio, USA.
authors.forename: Tyler
authors.initials: T
authors.lastname: Stevens
authors.affiliation: Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland, Ohio, USA.
authors.forename: John J
authors.initials: JJ
authors.lastname: Vargo
authors.affiliation: Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Raed A
authors.initials: RA
authors.lastname: Dweik
mesh_terms: D000079:Acetaldehyde / Q000032:analysis; D000096:Acetone / Q000032:analysis; D001554:Benzene / Q000032:analysis; D001646:Bile / Q000737:chemistry*; D001660:Biliary Tract Diseases / Q000175:diagnosis; D002246:Carbon Disulfide / Q000032:analysis; D016022:Case-Control Studies; D042883:Choledocholithiasis / Q000175:diagnosis*; D003251:Constriction, Pathologic / Q000175:diagnosis; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D013058:Mass Spectrometry; D008744:Methylamines / Q000032:analysis; D010190:Pancreatic Neoplasms / Q000175:diagnosis*; D050500:Pancreatitis, Chronic / Q000175:diagnosis*; D010420:Pentanes / Q000032:analysis; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D046628:Sphincter of Oddi Dysfunction / Q000175:diagnosis*; D055549:Volatile Organic Compounds / Q000032:analysis*
chemical_list: D008744:Methylamines; D010420:Pentanes; D055549:Volatile Organic Compounds; D000096:Acetone; C033353:pentane; D000079:Acetaldehyde; D001554:Benzene; C023336:trimethylamine; D002246:Carbon Disulfide