Urinary volatile organic compound testing to aid triage for flexible endoscopy in fast-track patients with suspected colorectal cancer.
EAES Academy. Vlachou F. 07/05/22; 362993; P036
Florentia Vlachou
Contributions
Contributions
Abstract
Background:
Colorectal symptoms are common but only infrequently represent serious pathology including colorectal cancer (CRC). A large number of invasive tests, such as colonoscopy, are presently performed despite a relatively small rate of CRC detection. We investigated the feasibility of urinary volatile organic compound (VOC) testing as a potential triage tool for flexible endoscopy in patients fast-tracked for assessment for possible CRC.
Methods:
A prospective, multi-centre, observational feasibility study was performed across three sites. Patients referred on NHS fast-track pathways for potential CRC provided a urine sample which underwent Gas Chromatography Mass Spectrometry (GC-MS), Field Asymmetric Ion Mobility Spectrometry (FAIMS) and Selected Ion Flow Tube Mass Spectrometry analysis (SIFT-MS). Patients underwent colonoscopy and/or computed tomography (CT) colonography and were grouped as either CRC, adenomatous polyp(s) or controls for the diagnostic accuracy exploration of VOC output data. An artificial neural network (ANN) was used in the analsyis and developed using samples from 70%of the cohort, then tested on the remaining samples.
Results:
558 patients participated with 23 (4.1%) CRC diagnosed. Fifty nine percent of colonoscopies, and 86% of CT colonographies showed no abnormalities. Use of VOC testing was feasible and applicable within the clinical fast track pathway, and patient feedback supported the acceptability of the testing method. GC-MS showed the highest clinical utility for CRC and polyp detection vs. controls (sensitivity=0.878, specificity=0.882, AUROC=0.884).
Conclusion:
Urinary VOC analysis is feasible as a triage tool in fast-track health services pathways, and acceptable to patients. Clinically meaningful differences between those with cancer, polyps or no pathology can be detected. This route of non-invasive testing may have future utility as a triage tool to reduce the need for colonscopy of patients presenting with colorectal symptoms.
Colorectal symptoms are common but only infrequently represent serious pathology including colorectal cancer (CRC). A large number of invasive tests, such as colonoscopy, are presently performed despite a relatively small rate of CRC detection. We investigated the feasibility of urinary volatile organic compound (VOC) testing as a potential triage tool for flexible endoscopy in patients fast-tracked for assessment for possible CRC.
Methods:
A prospective, multi-centre, observational feasibility study was performed across three sites. Patients referred on NHS fast-track pathways for potential CRC provided a urine sample which underwent Gas Chromatography Mass Spectrometry (GC-MS), Field Asymmetric Ion Mobility Spectrometry (FAIMS) and Selected Ion Flow Tube Mass Spectrometry analysis (SIFT-MS). Patients underwent colonoscopy and/or computed tomography (CT) colonography and were grouped as either CRC, adenomatous polyp(s) or controls for the diagnostic accuracy exploration of VOC output data. An artificial neural network (ANN) was used in the analsyis and developed using samples from 70%of the cohort, then tested on the remaining samples.
Results:
558 patients participated with 23 (4.1%) CRC diagnosed. Fifty nine percent of colonoscopies, and 86% of CT colonographies showed no abnormalities. Use of VOC testing was feasible and applicable within the clinical fast track pathway, and patient feedback supported the acceptability of the testing method. GC-MS showed the highest clinical utility for CRC and polyp detection vs. controls (sensitivity=0.878, specificity=0.882, AUROC=0.884).
Conclusion:
Urinary VOC analysis is feasible as a triage tool in fast-track health services pathways, and acceptable to patients. Clinically meaningful differences between those with cancer, polyps or no pathology can be detected. This route of non-invasive testing may have future utility as a triage tool to reduce the need for colonscopy of patients presenting with colorectal symptoms.
Background:
Colorectal symptoms are common but only infrequently represent serious pathology including colorectal cancer (CRC). A large number of invasive tests, such as colonoscopy, are presently performed despite a relatively small rate of CRC detection. We investigated the feasibility of urinary volatile organic compound (VOC) testing as a potential triage tool for flexible endoscopy in patients fast-tracked for assessment for possible CRC.
Methods:
A prospective, multi-centre, observational feasibility study was performed across three sites. Patients referred on NHS fast-track pathways for potential CRC provided a urine sample which underwent Gas Chromatography Mass Spectrometry (GC-MS), Field Asymmetric Ion Mobility Spectrometry (FAIMS) and Selected Ion Flow Tube Mass Spectrometry analysis (SIFT-MS). Patients underwent colonoscopy and/or computed tomography (CT) colonography and were grouped as either CRC, adenomatous polyp(s) or controls for the diagnostic accuracy exploration of VOC output data. An artificial neural network (ANN) was used in the analsyis and developed using samples from 70%of the cohort, then tested on the remaining samples.
Results:
558 patients participated with 23 (4.1%) CRC diagnosed. Fifty nine percent of colonoscopies, and 86% of CT colonographies showed no abnormalities. Use of VOC testing was feasible and applicable within the clinical fast track pathway, and patient feedback supported the acceptability of the testing method. GC-MS showed the highest clinical utility for CRC and polyp detection vs. controls (sensitivity=0.878, specificity=0.882, AUROC=0.884).
Conclusion:
Urinary VOC analysis is feasible as a triage tool in fast-track health services pathways, and acceptable to patients. Clinically meaningful differences between those with cancer, polyps or no pathology can be detected. This route of non-invasive testing may have future utility as a triage tool to reduce the need for colonscopy of patients presenting with colorectal symptoms.
Colorectal symptoms are common but only infrequently represent serious pathology including colorectal cancer (CRC). A large number of invasive tests, such as colonoscopy, are presently performed despite a relatively small rate of CRC detection. We investigated the feasibility of urinary volatile organic compound (VOC) testing as a potential triage tool for flexible endoscopy in patients fast-tracked for assessment for possible CRC.
Methods:
A prospective, multi-centre, observational feasibility study was performed across three sites. Patients referred on NHS fast-track pathways for potential CRC provided a urine sample which underwent Gas Chromatography Mass Spectrometry (GC-MS), Field Asymmetric Ion Mobility Spectrometry (FAIMS) and Selected Ion Flow Tube Mass Spectrometry analysis (SIFT-MS). Patients underwent colonoscopy and/or computed tomography (CT) colonography and were grouped as either CRC, adenomatous polyp(s) or controls for the diagnostic accuracy exploration of VOC output data. An artificial neural network (ANN) was used in the analsyis and developed using samples from 70%of the cohort, then tested on the remaining samples.
Results:
558 patients participated with 23 (4.1%) CRC diagnosed. Fifty nine percent of colonoscopies, and 86% of CT colonographies showed no abnormalities. Use of VOC testing was feasible and applicable within the clinical fast track pathway, and patient feedback supported the acceptability of the testing method. GC-MS showed the highest clinical utility for CRC and polyp detection vs. controls (sensitivity=0.878, specificity=0.882, AUROC=0.884).
Conclusion:
Urinary VOC analysis is feasible as a triage tool in fast-track health services pathways, and acceptable to patients. Clinically meaningful differences between those with cancer, polyps or no pathology can be detected. This route of non-invasive testing may have future utility as a triage tool to reduce the need for colonscopy of patients presenting with colorectal symptoms.
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