title: Mass Spectrometric Analysis of Exhaled Breath for the Identification of Volatile Organic Compound Biomarkers in Esophageal and Gastric Adenocarcinoma.
abstract: OBJECTIVE
  The present study assessed whether exhaled breath analysis using Selected Ion Flow Tube Mass Spectrometry could distinguish esophageal and gastric adenocarcinoma from noncancer controls.
  
  
  BACKGROUND
  The majority of patients with upper gastrointestinal cancer present with advanced disease, resulting in poor long-term survival rates. Novel methods are needed to diagnose potentially curable upper gastrointestinal malignancies.
  
  
  METHODS
  A Profile-3 Selected Ion Flow Tube Mass Spectrometry instrument was used for analysis of volatile organic compounds (VOCs) within exhaled breath samples. All study participants had undergone upper gastrointestinal endoscopy on the day of breath sampling. Receiver operating characteristic analysis and a diagnostic risk prediction model were used to assess the discriminatory accuracy of the identified VOCs.
  
  
  RESULTS
  Exhaled breath samples were analyzed from 81 patients with esophageal (N = 48) or gastric adenocarcinoma (N = 33) and 129 controls including Barrett's metaplasia (N = 16), benign upper gastrointestinal diseases (N = 62), or a normal upper gastrointestinal tract (N = 51). Twelve VOCs-pentanoic acid, hexanoic acid, phenol, methyl phenol, ethyl phenol, butanal, pentanal, hexanal, heptanal, octanal, nonanal, and decanal-were present at significantly higher concentrations (P < 0.05) in the cancer groups than in the noncancer controls. The area under the ROC curve using these significant VOCs to discriminate esophageal and gastric adenocarcinoma from those with normal upper gastrointestinal tracts was 0.97 and 0.98, respectively. The area under the ROC curve for the model and validation subsets of the diagnostic prediction model was 0.92 ± 0.01 and 0.87 ± 0.03, respectively.
  
  
  CONCLUSIONS
  Distinct exhaled breath VOC profiles can distinguish patients with esophageal and gastric adenocarcinoma from noncancer controls.
authors.affiliation: *Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK †Department of Medicine, Imperial College London, St Mary's Hospital, London, UK ‡Department of Surgery and Interventional Science, National Medical Laser Centre, University College London, London, UK §J. Heyrovsky Institute of Physical Chemistry, Academy of Sciences of the Czech Republic, Prague, Czech Republic ¶Institute for Science and Technology in Medicine, Keele University, Guy Hilton Research Centre, Hartshill, UK.
authors.forename: Sacheen
authors.initials: S
authors.lastname: Kumar
authors.forename: Juzheng
authors.initials: J
authors.lastname: Huang
authors.forename: Nima
authors.initials: N
authors.lastname: Abbassi-Ghadi
authors.forename: Hugh A
authors.initials: HA
authors.lastname: Mackenzie
authors.forename: Kirill A
authors.initials: KA
authors.lastname: Veselkov
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Hoare
authors.forename: Laurence B
authors.initials: LB
authors.lastname: Lovat
authors.forename: Patrik
authors.initials: P
authors.lastname: Španěl
authors.forename: David
authors.initials: D
authors.lastname: Smith
authors.forename: George B
authors.initials: GB
authors.lastname: Hanna
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000378:metabolism; D000368:Aged; D014408:Biomarkers, Tumor / Q000378:metabolism*; D001944:Breath Tests; D016022:Case-Control Studies; D003661:Decision Support Techniques; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000378:metabolism; D045853:Exhalation; D005260:Female; D006801:Humans; D008297:Male; D013058:Mass Spectrometry; D008875:Middle Aged; D012372:ROC Curve; D018570:Risk Assessment; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000378:metabolism; D055549:Volatile Organic Compounds / Q000378:metabolism*
chemical_list: D014408:Biomarkers, Tumor; D055549:Volatile Organic Compounds