The role of mass spectrometry-proton transfer reaction in the diagnosis of esophageal cancer (Part 2)

This is an automatically translated article.

Posted by Master, Doctor Mai Vien Phuong - Gastrointestinal Endoscopy - Department of Medical Examination & Internal Medicine - Vinmec Central Park International Hospital
Proton Transfer Reaction-Mass Spectrometry is a method of using breath to check patients for esophageal cancer.

1. Urgent biomarkers of esophageal cancer

1.1 Blood biomarkers Autoantibodies have attracted interest as serological markers for esophageal cancer, due to their stability and persistence in serum samples. With improvements in antibody detection technology raising the detection limit, there is increasing interest in the utility of autoantibodies as diagnostic and prognostic biomarkers for esophageal cancer. Perhaps the most comprehensively studied is the tumor suppressor gene, TP53. The protein product of TP53 is a nuclear phosphoprotein and in normal human plasma, TP53 protein and anti-p53 antibodies are absent.
1.2 The role of miRNA strand miRNA is a single-stranded, non-coding RNA that can regulate the expression of genes and proteins. miRNAs are highly expressed in a stable form, with high levels of inter-individual consistency in a variety of extracellular fluids including serum and plasma, and have attracted attention as biomarkers for cancer. mail and illness. Recent studies have reported circulating plasma/serum miRNAs as potential diagnostic and prognostic markers in several gastrointestinal cancers - esophageal squamous cell carcinoma, esophageal adenocarcinoma, stomach and colon. Although still an emerging area of ​​research, recent meta-analyses have highlighted the potential of circulating miRNAs in the detection of esophageal cancer.

1.3 Role of breath biomarkers Breath analysis represents an attractive way to detect cancer early, as it is completely non-invasive, relatively inexpensive compared to conventional methods, and provides provide quick results after sample collection. Breathable volatile organic compounds (VOCs) as biomarkers of disease have been recognized since the time of Hippocrates of Ancient Greece, who described fetal and fetal liver in his treatise on bad breath and sickness. It is now known that a human breath is a complex gaseous mixture of more than 2000 unique VOCs, representing a reservoir of potential cancer biomarkers. Breath VOCs have shown clinical utility as possible biomarkers for lung, breast, prostate, colorectal, gastric and, more recently, esophageal cancers.
Many studies have shown that breath alkanes are associated with cancer, perhaps as a biological product of the oxidative stress pathway. Breath ethane was previously studied in end-stage esophageal squamous cell carcinoma and adenocarcinoma, with no difference from healthy controls. More advanced technologies have been used to characterize VOCs associated with esophageal cancer. Headspace analysis of urine and gastric contents from esophageal cancer patients using selected ion-flow tube mass spectrometry identified a number of VOCs that were differentially regulated compared with healthy controls. However, there is no dominant group of VOCs in the cancer group.

1.4 Breath test - a new means of diagnosing esophageal cancer The first breath analysis study to determine breath VOCs in esophageal cancer identified the dominant expression pattern of phenol, with phenol, methyl phenol , ethyl phenol and hexanoic acid were significantly increased in esophageal cancer compared with healthy controls. In the most comprehensive study to date, Kumar et al investigated breath VOCs in esophageal squamous cell carcinoma, esophageal adenocarcinoma, Barrett's esophagus, and benign and cancerous conditions. gastric adenocarcinoma, compared with healthy controls. A total of 12 VOCs, including phenols, aldehydes, and fatty acids, were identified as discriminating against esophageal and gastric cancers compared with normal upper gastrointestinal (GI) tracts.
In addition, the authors found that the VOC profile distinguishes esophageal cancer from Barrett's metaplasia and from benign conditions of the upper gastrointestinal tract (including esophagitis, esophageal stricture, and esophageal candidiasis). ). Developing a risk prediction model, the authors reported eight important predictors for adenocarcinoma: decanal, nonanal, phenol, ethyl phenol, methyl phenol, hexanoic acid, heptanal and butyric acid, with a sensitivity and specificity of 98% and 91.7%, respectively, when compared with the normal upper gastrointestinal tract. Furthermore, the model correctly distinguished esophageal adenocarcinoma from noncancerous controls (benign condition, Barrett metaplasia, and normal upper gastrointestinal tract), with sensitivity and specificity. are 87.5% and 82.9%, respectively. Interestingly, no difference in VOCs was detected between early- and late-stage cancers, or between tumor size and VOCs concentrations.
1.5 The role of mass spectrometry-proton transfer reaction – a new breath test method for the diagnosis of esophageal cancer

Proton transfer-response mass spectrometry was recently used to determine breath VOCs in a small study in Chinese esophageal cancer patients. Although the study did not distinguish between esophageal squamous cell carcinoma and esophageal adenocarcinoma, the authors reported 20 ion peaks in the full mass spectrometry that were significantly different in cancer patients compared with esophageal adenocarcinoma. with healthy control group. Using stepwise discriminant analysis, the authors identified seven ions that were highly discriminating for esophageal cancer. In contrast to the study by Kumar et al., the authors also suggest that their predictive model distinguishes between early and late-stage cancers. However, these interpretations should be carefully balanced with the small number of participants used in the study.

2. Conclusion

The recently developed field of breath and gas analysis for cancer detection represents a completely non-invasive approach to early detection and continuous screening of those at risk. With improvements in the sensitivity of VOC detection technology, it is likely that the pool of breath and odor biomarkers will increase significantly. Although there are relatively few studies investigating breath biomarkers in esophageal cancer, early predictive models have shown some promise. Moving forward in this rapidly growing field, it is important to use standard approaches to breath sample collection, to minimize research heterogeneity. Furthermore, there is little evidence to support the biological origin of VOCs.
As the incidence of esophageal cancer continues to increase worldwide, new diagnostic and prognostic tools are needed to improve survival and direct clinical management. Advances being made in new minimal and non-invasive biomarkers represent a suite of ancillary tests that can stratify patients for endoscopy and other imaging modalities, ultimately leading to to improve patient care. While it is unlikely that there will be a single “silver bullet” biomarker, the most likely scenario would be derived from prediction algorithms based on multiple biomarkers, which may also include combined blood and breath analysis.
Currently, screening for gastrointestinal cancer is a scientific and effective measure for early detection of gastrointestinal cancer (esophageal cancer, stomach cancer, colon cancer) and giving a treatment plan. best treatment. Currently, Vinmec International General Hospital has a package of screening and early detection of cancers of the gastrointestinal tract (esophagus - stomach - colon) combined with clinical and paraclinical examination to bring the most accurate results. maybe.
When screening for gastrointestinal cancer at Vinmec, you will receive:
Gastrointestinal specialty examination with an oncologist (by appointment). Gastroscopy and colonoscopy with an NBI endoscope with anesthesia. Peripheral blood count (laser counter). Automated prothrombin time test. Automated thrombin time test. Activated Partial Thromboplastin Time (APTT) test using an automated machine. General abdominal ultrasound

Please dial HOTLINE for more information or register for an appointment HERE. Download MyVinmec app to make appointments faster and to manage your bookings easily.

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