title: Detection of precancerous gastric lesions and gastric cancer through exhaled breath.
abstract: OBJECTIVE
  Timely detection of gastric cancer (GC) and the related precancerous lesions could provide a tool for decreasing both cancer mortality and incidence.
  
  
  METHODS
  968 breath samples were collected from 484 patients (including 99 with GC) for two different analyses. The first sample was analysed by gas chromatography linked to mass spectrometry (GCMS) while applying t test with multiple corrections (p value<0.017); the second by cross-reactive nanoarrays combined with pattern recognition. For the latter, 70% of the samples were randomly selected and used in the training set while the remaining 30% constituted the validation set. The operative link on gastric intestinal metaplasia (OLGIM) assessment staging system was used to stratify the presence/absence and risk level of precancerous lesions. Patients with OLGIM stages III-IV were considered to be at high risk.
  
  
  RESULTS
  According to the GCMS results, patients with cancer as well as those at high risk had distinctive breath-print compositions. Eight significant volatile organic compounds (p value<0.017) were detected in exhaled breath in the different comparisons. The nanoarray analysis made it possible to discriminate between the patients with GC and the control group (OLGIM 0-IV) with 73% sensitivity, 98% specificity and 92% accuracy. The classification sensitivity, specificity, and accuracy between the subgroups was as follows: GC versus OLGIM 0-II-97%, 84% and 87%; GC versus OLGIM III-IV-93%, 80% and 90%; but OLGIM I-II versus OLGIM III-IV and dysplasia combined-83%, 60% and 61%, respectively.
  
  
  CONCLUSIONS
  Nanoarray analysis could provide the missing non-invasive screening tool for GC and related precancerous lesions as well as for surveillance of the latter.
  
  
  BACKGROUND
  Clinical Trials.gov number, NCT01420588 (3/11/2013).
authors: Department of Chemical Engineering and Russell Berrie Nanotechnology Institute, Technion-Israel Institute of Technology, Haifa, Israel.
authors: Haitham
authors: H
authors: Amal
authors: Faculty of Medicine, University of Latvia, Riga, Latvia Department of Research, Riga East University Hospital, Riga, Latvia Digestive Diseases Centre GASTRO, Riga, Latvia.
authors: Marcis
authors: M
authors: Leja
authors: Faculty of Medicine, University of Latvia, Riga, Latvia Department of Research, Riga East University Hospital, Riga, Latvia Digestive Diseases Centre GASTRO, Riga, Latvia.
authors: Konrads
authors: K
authors: Funka
authors: Faculty of Medicine, University of Latvia, Riga, Latvia Department of Research, Riga East University Hospital, Riga, Latvia.
authors: Roberts
authors: R
authors: Skapars
authors: Faculty of Medicine, University of Latvia, Riga, Latvia Department of Research, Riga East University Hospital, Riga, Latvia.
authors: Armands
authors: A
authors: Sivins
authors: Faculty of Medicine, University of Latvia, Riga, Latvia Department of Research, Riga East University Hospital, Riga, Latvia.
authors: Guntis
authors: G
authors: Ancans
authors: Faculty of Medicine, University of Latvia, Riga, Latvia Department of Research, Riga East University Hospital, Riga, Latvia Academic Histology laboratory, Riga, Latvia.
authors: Inta
authors: I
authors: Liepniece-Karele
authors: Faculty of Medicine, University of Latvia, Riga, Latvia Digestive Diseases Centre GASTRO, Riga, Latvia.
authors: Ilze
authors: I
authors: Kikuste
authors: Faculty of Medicine, University of Latvia, Riga, Latvia.
authors: Ieva
authors: I
authors: Lasina
authors: Department of Chemical Engineering and Russell Berrie Nanotechnology Institute, Technion-Israel Institute of Technology, Haifa, Israel.
authors: Hossam
authors: H
authors: Haick
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism*; D001944:Breath Tests / Q000379:methods; D055088:Early Detection of Cancer / Q000379:methods*; D045853:Exhalation; D005260:Female; D006801:Humans; D008297:Male; D046228:Microarray Analysis; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000378:metabolism; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000378:metabolism; D055549:Volatile Organic Compounds / Q000378:metabolism*
chemical_list: D014408:Biomarkers, Tumor; D055549:Volatile Organic Compounds
keywords: GASTRIC CANCER; GASTRIC PRE-CANCER