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Volatile Organic Compounds in Bile Can Distinguish Pancreatic Cancer from Chronic Pancreatitis-A Prospective Observational Study.

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


METHODS
In this prospective observational study, bile was aspirated in patients undergoing ERCP for CP and PC. The head space of bile from PC and CP patients was analyzed using mass spectrometry.


RESULTS
The study included a discovery cohort of 57 patients (PC = 46, CP = 11) and a validation cohort of 31 patients (PC = 19, CP = 12). 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 PC with a sensitivity of 93.5% and specificity of 100%; likelihood ratio: 40.9; Area under the curve [AUC] = 0.98; 95% confidence interval [CI]: 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 helps to accurately distinguish PC from CP. (NCT02531607).