Navaneethan, Udayakumar, Parsi, Mansour A., Lourdusamy, Dennisdhilak, Grove, David, Sanaka, Madhusudhan R., Hammel, Jeffrey P., Vargo, John J., Dweik, Raed A.
funding text
We also would like to thank the Clinical Research Unit members at the Cleveland Clinic who helped in processing the urine samples. The study was supported by a research grant from the American College of Gastroenterology (ACG) Grant (to U.N), BRCP 08-049 Tech 09-003 Third Frontier Program grant from the Ohio Department of Development (ODOD) [to R.D] and in part by the National Institutes of Health, National Center for Research Resources, CTSA, UL1TR 000439-06 Cleveland, Ohio. Dr Dweik was also supported by the following grants: HL107147, HL081064, HL103453, HL109250, and RR026231 from the National Institutes of Health (NIH).
abstract
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. To identify potential VOCs in urine to diagnose malignant biliary strictures. 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. 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)] a parts per thousand yen 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)] a parts per thousand currency sign 169.9 could identify CCA with 80 % sensitivity and 100 % specificity (AUC = 0.9). Measurement of VOCs in urine may diagnose malignant biliary strictures noninvasively.