8 maart 2013: Bron: BBC

Een ademtest kan maagkanker in een vroeg stadium opsporen en kan de kans op een succesvolle behandeling van maagkanker sterk vergroten. Dit meldt de BBC naar aanleiding van een studie die wetenschappers uit China en Israël hebben uitgevoerd en is gepubliceerd in BJC - the British Journal of Cancer. Volgens de onderzoekers is de test 90 procent nauwkeurig bij het detecteren van maagkanker en onderscheidt deze van andere aandoeningen in de maag.

De test analyseert uit de uitgeademde lucht chemische stoffen die typerend zijn voor maagkanker.

Aan de studie namen in totaal 130 patiënten deel. 37 patiënten bleken maagkanker te hebben, 32 patiënten hadden maagzweren en 61 patiënten hadden verschillende andere maagklachten. Uit de test kwam een betrouwbaarheidscijfer van 90 procent.
Naast het onderscheiden van kwaadaardige maagtumoren van goedaardige, toonde de test ook aan of de kanker nog in een vroeg stadium was of al in een gevorderd stadium.

Op dit moment wordt een diagnose van maagkanker gesteld door een voor patiënten vervelend en belastend onderzoek. Via de mond en slokdarm wordt een flexibele slang ingebracht tot aan de maagwand
om zo het maagslijmvlies te bekijken en eventueel een biopt van een aanwezige tumor te nemen.

Maagkanker wordt meestal veroorzaakt door een Helicobacter pylori infectie en er is ook al veel onderzoek gedaan naar het opsporen van die infectie. Hieronder het abstract van een meta analyse van drie veelgebruikte testen voor opsporen van een Helicobacter pylori infectie

Op de website van de BBC  staat een verslag van deze studie waaruit ik bovenstaand artikel heb gecomponeerd. Het volledige studieverslag van de ademtest studie: A nanomaterial-based breath test for distinguishing gastric cancer from benign gastric conditions. is tegen betaling te in te zien op de website van het British Journal of Cancer. Onderaan artikel het abstract van deze studie:

Hier eerst het abstract van de meta analyse: Diagnostic performance of urea breath test, rapid urea test, and histology for Helicobacter pylori infection in patients with partial gastrectomy: a meta-analysis 

Among the three commonly used tests, histological examination performs the best, followed by the rapid urease test, for the diagnosis of H. pylori infection after partial gastrectomy

2012 Apr;46(4):285-92. doi: 10.1097/MCG.0b013e318249c4cd.

Diagnostic performance of urea breath test, rapid urea test, and histology for Helicobacter pylori infection in patients with partial gastrectomy: a meta-analysis.

Source

Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.

Abstract

BACKGROUND:

Helicobacter pylori infection has been implicated in the pathogenesis of gastroduodenal diseases such as recurrent peptic ulceration and particularly residual stomach cancer in the postoperative stomach.

AIM:

To determine the performance of different commonly used tests for the diagnosis of H. pylori infection in patients after partial gastrectomy.

METHODS:

A systematic literature search was conducted by searching the PubMed, EMBASE and ScienceDirect databases with relevant key words. Data extraction was independently performed by two reviewers. Meta-analyses were performed for the performance of the different tests including the sensitivities, specificities, likelihood ratios (LRs), diagnostic odds ratio diagnostic odds ratio, and the summary receiver operating characteristic summary receiver operating characteristic curve. The meta-analysis was performed by Meta-DiSc software.

RESULTS:

Studies showed a high degree of heterogeneity. Pooled sensitivity, specificity, LR+, LR- and diagnostic odds ratio for the different methods were: Urea breath test (9 studies): 0.77 (95% CI, 0.72-0.82), 0.89 (95% CI, 0.85-0.93), 6.32 (95% CI, 3.22-12.42), 0.27 (95% CI, 0.17-0.43), and 27.86 (95% CI, 13.27-58.49). Rapid urease test (7 studies): 0.79 (95% CI, 0.72-0.84), 0.94 (95% CI, 0.90-0.97), 10.21 (95% CI, 5.94-17.54), 0.28 (95% CI, 0.22-0.36) and 49.02 (95% CI, 24.24-99.14). Histology (3 studies): 0.93 (95% CI, 0.88-0.97), 0.85 (95% CI, 0.73-0.93), 5.88 (95% CI, 3.26-10.60), 0.09 (95% CI, 0.05- 0.15), and 97.28 (95% CI, 34.30-275.95). The corresponding summary receiver operating characteristic curves showed areas under the curves of 0.91, 0.93 and 0.96 and Q* values of 0.84, 0.86 and 0.91, respectively

CONCLUSION:

Among the three commonly used tests, histological examination performs the best, followed by the rapid urease test, for the diagnosis of H. pylori infection after partial gastrectomy. Thus, histology, preferably after the rapid urease test, is recommended for the diagnosis of H. pylori infection after partial gastrectomy.

Comment in

PMID:
22392025
[PubMed - indexed for MEDLINE]

A nanomaterial-based breath test for distinguishing gastric cancer from benign gastric conditions

British Journal of Cancer 108, 941-950 (5 March 2013) | doi:10.1038/bjc.2013.44

A nanomaterial-based breath test for distinguishing gastric cancer from benign gastric conditions

Z-q Xu, Y Y Broza, R Ionsecu, U Tisch, L Ding, H Liu, Q Song, Y-y Pan, F-x Xiong, K-s Gu, G-p Sun, Z-d Chen, M Leja and H Haick

Background:

Upper digestive endoscopy with biopsy and histopathological evaluation of the biopsy material is the standard method for diagnosing gastric cancer (GC). However, this procedure may not be widely available for screening in the developing world, whereas in developed countries endoscopy is frequently used without major clinical gain. There is a high demand for a simple and non-invasive test for selecting the individuals at increased risk that should undergo the endoscopic examination. Here, we studied the feasibility of a nanomaterial-based breath test for identifying GC among patients with gastric complaints.

Methods:

Alveolar exhaled breath samples from 130 patients with gastric complaints (37 GC/32 ulcers / 61 less severe conditions) that underwent endoscopy/biopsy were analyzed using nanomaterial-based sensors. Predictive models were built employing discriminant factor analysis (DFA) pattern recognition, and their stability against possible confounding factors (alcohol/tobacco consumption; Helicobacter pylori) was tested. Classification success was determined (i) using leave-one-out cross-validation and (ii) by randomly blinding 25% of the samples as a validation set. Complementary chemical analysis of the breath samples was performed using gas chromatography coupled with mass spectrometry.

Results:

Three DFA models were developed that achieved excellent discrimination between the subpopulations: (i) GC vs benign gastric conditions, among all the patients (89% sensitivity; 90% specificity); (ii) early stage GC (I and II) vs late stage (III and IV), among GC patients (89% sensitivity; 94% specificity); and (iii) ulcer vs less severe, among benign conditions (84% sensitivity; 87% specificity). The models were insensitive against the tested confounding factors. Chemical analysis found that five volatile organic compounds (2-propenenitrile, 2-butoxy-ethanol, furfural, 6-methyl-5-hepten-2-one and isoprene) were significantly elevated in patients with GC and/or peptic ulcer, as compared with less severe gastric conditions. The concentrations both in the room air and in the breath samples were in the single p.p.b.v range, except in the case of isoprene. 

Conclusion:

The preliminary results of this pilot study could open a new and promising avenue to diagnose GC and distinguish it from other gastric diseases. It should be noted that the applied methods are complementary and the potential marker compounds identified by gas-chromatography/mass spectrometry are not necessarily responsible for the differences in the sensor responses. Although this pilot study does not allow drawing far-reaching conclusions, the encouraging preliminary results presented here have initiated a large multicentre clinical trial to confirm the observed patterns for GC and benign gastric conditions.


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