title: Volatile Organic Compounds in Urine for Noninvasive Diagnosis of Malignant Biliary Strictures: A Pilot Study.
abstract: BACKGROUND
  The use of volatile organic compounds (VOCs) in bile was recently studied and appeared promising for diagnosis of malignancy. Noninvasive diagnosis of malignant biliary strictures by using VOCs in urine has not been studied.
  
  
  OBJECTIVE
  To identify potential VOCs in urine to diagnose malignant biliary strictures.
  
  
  METHODS
  In this prospective cross-sectional study, urine was obtained immediately prior to ERCP from consecutive patients with biliary strictures. Selected-ion flow-tube mass spectrometry was used to analyze the concentration of VOCs in urine samples.
  
  
  RESULTS
  Fifty-four patients with biliary strictures were enrolled. Fifteen patients had malignant stricture [six cholangiocarcinoma (CCA) and nine pancreatic cancer], and 39 patients had benign strictures [10 primary sclerosing cholangitis (PSC) and 29 with benign biliary conditions including chronic pancreatitis and papillary stenosis]. The concentration of several compounds (ethanol and 2-propanol) was significantly different in patients with malignant compared with benign biliary strictures (p < 0.05). Using receiver operating characteristic curve analysis, we developed a model for the diagnosis of malignant biliary strictures adjusted for age and gender based on VOC levels of 2-propranol, carbon disulfide, and trimethyl amine (TMA). The model [-2.4191 * log(2-propanol) + 1.1617 * log(TMA) - 1.2172 * log(carbon disulfide)] ≥ 7.73 identified the patients with malignant biliary stricture [area under the curve (AUC = 0.83)], with 93.3 % sensitivity and 61.5 % specificity (p = 0.009). Comparing patients with CCA and PSC, the model [38.864 * log(ethane) - 3.989 * log(1-octene)] ≤ 169.9 could identify CCA with 80 % sensitivity and 100 % specificity (AUC = 0.9).
  
  
  CONCLUSIONS
  Measurement of VOCs in urine may diagnose malignant biliary strictures noninvasively.
authors.affiliation: Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland, OH, USA, udhaykumar81@gmail.com.
authors.forename: Udayakumar
authors.initials: U
authors.lastname: Navaneethan
authors.forename: Mansour A
authors.initials: MA
authors.lastname: Parsi
authors.forename: Dennisdhilak
authors.initials: D
authors.lastname: Lourdusamy
authors.forename: David
authors.initials: D
authors.lastname: Grove
authors.forename: Madhusudhan R
authors.initials: MR
authors.lastname: Sanaka
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Hammel
authors.forename: John J
authors.initials: JJ
authors.lastname: Vargo
authors.forename: Raed A
authors.initials: RA
authors.lastname: Dweik
mesh_terms: D001650:Bile Duct Neoplasms / Q000175:diagnosis* / Q000652:urine; D001652:Bile Ducts / Q000473:pathology*; D001653:Bile Ducts, Intrahepatic / Q000473:pathology; D018281:Cholangiocarcinoma / Q000175:diagnosis / Q000652:urine; D015209:Cholangitis, Sclerosing / Q000175:diagnosis / Q000652:urine; D003251:Constriction, Pathologic / Q000175:diagnosis* / Q000652:urine; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000652:urine; D055549:Volatile Organic Compounds / Q000652:urine*
chemical_list: D055549:Volatile Organic Compounds