Breath test for the diagnosis of oesophageal squamous cell carcinoma Yan Mei Goh
Diagnosis of oesophago-gastric cancer • Upper GI symptoms account for 3% of consultations in primary care • 11,500 diagnosed annually in the UK Gut 2014; 63:250-61
Diagnostic dilemma in cancer High incidence non-specific symptoms Triage test + Low incidence cancer Tissue diagnosis
1971 Linus Pauling Concentrated breath in a cold trap Analyzed with GC >100 volatile organic compounds (VOCs)
Breath analysis
Biomarker discovery - Exhaled Breath
Multicentre oesophageal validation study JAMA Oncology | Original Investigation Noninvasive Exhaled Breath Volatile Organic Compound Analysis for the Diagnosis of Oesophagogastric Cancer Sheraz R. Markar, PhD; Tom Wiggins, PhD; Stefan Antonowicz, PhD; Sung-Tong Chin, PhD; Andrea Romano, PhD; Konstantin Nikolic, PhD; Benjamin Evans, PhD; David Cunningham, PhD; Muntzer Mughal, MD; Jesper Lagergren, PhD; George B. Hanna, PhD 1.0 0.8 0.6 Sensitivity Diagnostic accuracy 85% 0.4 0.2 0 0 0.2 0.4 0.6 0.8 1.0 1 – Specificity
Colorectal cancer O RIGINAL A RTICLE Breath Volatile Organic Compound Profiling of Colorectal Cancer Using Selected Ion Flow-Tube Mass Spectrometry Sheraz R. Markar, PhD, Sung-Tong Chin, PhD, Andrea Romano, PhD, Tom Wiggins, MRCS, Stefan Antonowicz, MRCS, Paraskevas Paraskeva, PhD, Paul Ziprin, FRCS, Ara Darzi, FRCS, and George B. Hanna, PhD Annals of Surgery 2017 5 0 4 0 3 0 Diagnostic accuracy 83% 2 0 1 0 0 C o n tr o l C R C a P o s to p R e c u r r e n c e D is e a s e g ro u p
Pancreatic cancer Original article Profile of exhaled-breath volatile organic compounds to diagnose pancreatic cancer S. R. Markar , B. Brodie, S.-T. Chin, A. Romano, D. Spalding and G. B. Hanna British Journal of Surgery 2018 1·0 0·8 0·6 Diagnostic accuracy 90% Sensitivity 0·4 0·2 0 0·2 0·4 0·6 0·8 1·0 1–specificity a
Breath collection system Identification GC-MS Breath sample Steel tube Quantification Collection device SIFT-MS PTR-TOF-MS Robust system for transport Stability for 4 weeks
Implementation into clinical practice One breath triage test for multiple cancers
Breath test assisted pathway Endoscopy / CT Patients with alarming symptoms +ve Patients with Triage PPI non-specific Re-test -ve symptoms Breath test
Plan for squamous cell cancer breath test Clinical Phenotyping Study Oesophageal Head and Healthy Positive Control SCC Neck SCC Control n=30 n=60 n=60 n=60
Breath collection system Identification GC-MS Breath sample Steel tube Quantification Collection device SIFT-MS PTR-TOF-MS Robust system for transport Stability for 4 weeks
t t s s i i L L e e c c i i r r P P Saliva collection system i i · · X X F F ™ ™ · X n n F ™ o o n i i t t o p p i t r r p o o r o s s s o o o s s s a a a N N N handle for the ease of nasal sampling. Nasosorption™ FX·i is supplied housed in a cryo or distribution which is limited to a number sations. Please see our full Terms and Conditions ingle-Use Non-Sterile Medical asosorption™ FX·i, working length 40mm, swab size 7 x 28mm long, 2 year shelf life. Imperial college 13485 (Medical Devices). The devi Nasosorption™ FX·i is a non cale): Identification to sca t to not ngs no Nasosorption™ FX·i, working length 39mm, swab size 4.5mm x 27mm long, 2 year shelf life. Imperial col rawing ce dra nge (device Quantification ng of device for adults. Nasosorption™ FX·i device Saliva GC-MS sample Collection device for children. device Robust system for transport
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