Tiankanon K, Pungpipattrakul N, Sukaram T, Chaiteerakij R, Rerknimitr R. Identification of breath volatile organic compounds to distinguish pancreatic adenocarcinoma, pancreatic cystic neoplasm, and patients without pancreatic lesions. World J Gastrointest Oncol 2024; 16(3): 894-906 [PMID: 38577457 DOI: 10.4251/wjgo.v16.i3.894]
Corresponding Author of This Article
Rungsun Rerknimitr, MD, Professor, Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University, 1873 Rama 4 Road, Pathumwan, Bangkok 10330, Thailand. cholangiogram@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Oncol. Mar 15, 2024; 16(3): 894-906 Published online Mar 15, 2024. doi: 10.4251/wjgo.v16.i3.894
Identification of breath volatile organic compounds to distinguish pancreatic adenocarcinoma, pancreatic cystic neoplasm, and patients without pancreatic lesions
Kasenee Tiankanon, Roongruedee Chaiteerakij, Rungsun Rerknimitr, Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
Co-first authors: Kasenee Tiankanon and Nuttanit Pungpipattrakul.
Author contributions: Chaiteerakij R and Tiankanon K are the guarantors and designed the study; Pungpipattrakul N and Sukaram T participated in data acquisition and analysis; Pungpipattrakul N, Tiankanon K, Sukaram T and Chaiteerakij R performed data interpretation; Pungpipattrakul N and Tiankanon K drafted the initial manuscript; Sukaram T, Chaiteerakij R and Rerknimitr R critically revised the article for important intellectual content; All authors approved the final version of the manuscript.
Institutional review board statement: The study protocol was reviewed and approved by the Institutional Research Committee, Faculty of Medicine, Chulalongkorn University (No. 0482/65) and registered in the Thai Clinical Trials Registry (TCTR20211109002).
Informed consent statement: All study participants or their legal guardians provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare there are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Corresponding author: Rungsun Rerknimitr, MD, Professor, Division of Gastroenterology, Faculty of Medicine, Chulalongkorn University, 1873 Rama 4 Road, Pathumwan, Bangkok 10330, Thailand. cholangiogram@gmail.com
Received: September 22, 2023 Peer-review started: September 22, 2023 First decision: December 4, 2023 Revised: December 19, 2023 Accepted: January 10, 2024 Article in press: January 10, 2024 Published online: March 15, 2024 Processing time: 171 Days and 18.4 Hours
Abstract
BACKGROUND
Volatile organic compounds (VOCs) are a promising potential biomarker that may be able to identify the presence of cancers.
AIM
To identify exhaled breath VOCs that distinguish pancreatic ductal adenocarcinoma (PDAC) from intraductal papillary mucinous neoplasm (IPMN) and healthy volunteers.
METHODS
We collected exhaled breath from histologically proven PDAC patients, radiological diagnosis IPMN, and healthy volunteers using the ReCIVA® device between 10/2021-11/2022. VOCs were identified by thermal desorption-gas chromatography/field-asymmetric ion mobility spectrometry and compared between groups.
RESULTS
A total of 156 participants (44% male, mean age 62.6 ± 10.6) were enrolled (54 PDAC, 42 IPMN, and 60 controls). Among the nine VOCs identified, two VOCs that showed differences between groups were dimethyl sulfide [0.73 vs 0.74 vs 0.94 arbitrary units (AU), respectively; P = 0.008] and acetone dimers (3.95 vs 4.49 vs 5.19 AU, respectively; P < 0.001). After adjusting for the imbalance parameters, PDAC showed higher dimethyl sulfide levels than the control and IPMN groups, with adjusted odds ratio (aOR) of 6.98 (95%CI: 1.15-42.17) and 4.56 (1.03-20.20), respectively (P < 0.05 both). Acetone dimer levels were also higher in PDAC compared to controls and IPMN (aOR: 5.12 (1.80-14.57) and aOR: 3.35 (1.47-7.63), respectively (P < 0.05 both). Acetone dimer, but not dimethyl sulfide, performed better than CA19-9 in PDAC diagnosis (AUROC 0.910 vs 0.796). The AUROC of acetone dimer increased to 0.936 when combined with CA19-9, which was better than CA19-9 alone (P < 0.05).
CONCLUSION
Dimethyl sulfide and acetone dimer are VOCs that potentially distinguish PDAC from IPMN and healthy participants. Additional prospective studies are required to validate these findings.
Core Tip: Participants with pancreatic ductal adenocarcinoma (PDAC) exhibit distinct exhaled breath volatile organic compounds (VOC) from those with intraductal papillary mucinous neoplasm (IPMN) or the general population. Dimethyl sulfide and acetone dimer are VOCs that could potentially identify PDAC from IPMN and healthy subjects.
