Volatile organic compound breath testing detects in-situ squamous cell carcinoma of bronchial and laryngeal regions and shows distinct profiles of each tumour.

Volatile organic compound (VOC) breath testing of lung and head and neck squamous cell carcinoma (SCC) has been widely studied, however little is known regarding VOC profiles of in-situ SCC. A prospective study of VOC in patients with histologically proven SCC, either in-situ or advanced, and controls. Breath samples were analysed using the E-nose Cyranose ®320 and by gas chromatography/mass spectroscopy. Predictive models were developed using bootstrap forest using all 32 sensors. Data from 55 participants was analysed: 42 SCC cases comprising 20 bronchial (10 in-situ, 10 advanced) and 22 laryngeal (12 in-situ, 10 advanced), and 13 controls. There were 32 (76%) male SCC cases with mean age 63.6 (SD = 9.5) compared with 11 (85%) male controls with mean age 61.9 (SD = 10.1). Predictive models for in situ cases had good sensitivity and specificity compared to controls (overall, 95% and 69%; laryngeal, 100% and 85%; bronchial, 77% and 80%). When distinguishing in-situ and advanced tumours, sensitivity and specificity 82% and 75% respectively. For different tumour types (bronchial versus advanced laryngeal) sensitivity and specificity were 100% and 80% respectively. VOCs isolated from in-situ cancers included some previously demonstrated in advanced cancers and some novel VOCs. In-situ bronchial and laryngeal cancer can be detected by VOC analysis. Distinction from normal controls and between the two tumour types could allow screening in high risk groups for these curable lesions.

Autofluorescence improves pretreatment mucosal assessment in head and neck cancer patients.

OBJECTIVE: Panendoscopy is used in selected patients with head and neck cancer to detect second primary disease. We hypothesized that adding autofluorescence to the bronchoscopy and laryngoscopy part of this procedure could add to the detection of clinically meaningful dysplasias and carcinomas in both the head and neck and bronchus, with resultant change in management. STUDY DESIGN: Prospective observational study on consecutive patients with head and neck cancer who had panendoscopy prior to surgery. SETTING: Teaching hospital, tertiary referral center. SUBJECTS AND METHODS: All patients had white-light inspection observed by ENT surgeons, followed by autofluorescence inspection of the head and neck tumor and surrounding area as well as the bronchus. Extra biopsies were taken from regions of abnormal fluorescence where there was no white-light abnormality. RESULTS: Sixty-six patients were studied; mean age 64.9 +/- 11 years. As a result of autofluorescence, 33 mucosal biopsies were taken from the head and neck and 37 from the bronchus. Histology included three carcinoma in situ lesions and four severe dysplasias. As a result of these autofluorescence biopsies, change of management occurred in four patients (6% of the total patients). Standard panendoscopy changed management in five patients. Therefore, standard panendoscopy led to change in management in only 55 percent of cases (CI 21%-86%, P = 0.02), with the rest detected by autofluorescence. CONCLUSION: Adding autofluorescence to panendoscopy in patients with head and neck cancer changed management in a clinically significant number of patients.