Volatile organic compounds in bile can distinguish pancreatic cancer from chronic pancreatitis: a prospective observational study

Udayakumar Navaneethan; Chad Spencer; Xiang Zhu; John J. Vargo; David Grove; Raed A. Dweik

doi:10.1055/a-1255-9169

Endoscopy, Table of Contents

Endoscopy 2021; 53(07): 732-736
DOI: 10.1055/a-1255-9169

Innovations and brief communications

Volatile organic compounds in bile can distinguish pancreatic cancer from chronic pancreatitis: a prospective observational study

Udayakumar Navaneethan

¹Center for Interventional Endoscopy, Orlando, Florida, United States

,

Chad Spencer

²Department of Gastroenterology and Hepatology, University of South Alabama College of Medicine, Mobile, Alabama, United States

,

Xiang Zhu

³Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, Florida, United States

,

John J. Vargo

⁴Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland, Ohio, United States

,

David Grove

⁵Pathobiology, Lerners Research Institute, Cleveland Clinic, Cleveland, Ohio, United States

,

Raed A. Dweik

⁵Pathobiology, Lerners Research Institute, Cleveland Clinic, Cleveland, Ohio, United States

› Author Affiliations

Abstract

Background Early and accurate diagnosis of pancreatic cancer is important. Our aim was to identify potential volatile organic compounds (VOCs) in the bile that can help distinguish pancreatic cancer from chronic pancreatitis.

Methods In this prospective observational study, bile was aspirated from patients undergoing endoscopic retrograde cholangiopancreatography for chronic pancreatitis and pancreatic cancer, and the gaseous headspace was analyzed using mass spectrometry.

Results The study included a discovery cohort of 57 patients (46 pancreatic cancer, 11 chronic pancreatitis) and a validation cohort of 31 patients (19 and 12, respectively). Using logistic regression analysis, the model [0.158 × age + 9.747 × log (ammonia) – 3.994 × log (acetonitrile) + 5.044 × log (trimethylamine) – 30.23] successfully identified patients with pancreatic cancer with a sensitivity of 93.5 % and specificity of 100 % (likelihood ratio 40.9, area under the curve 0.98, 95 % confidence interval 0.95 – 1.00). The diagnostic accuracy of this model was confirmed in the second independent validation cohort.

Conclusion The measurement of VOCs in bile helped to accurately distinguish pancreatic cancer from chronic pancreatitis.

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References

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