Alteration of the Exhaled Volatile Organic Compound Pattern in Colorectal Cancer Patients after Intentional Curative Surgery—A Prospective Pilot Study

SIMPLE SUMMARY: The current diagnostic modalities used during colorectal cancer follow-up appointments are known to have a limited sensitivity to detect recurrent disease. An electronic nose to detect volatile organic compounds (VOCs) in breath is shown to be a promising novel tool in the primary detection of lung cancer and colorectal cancer. To explore the potential role of an electronic nose in follow-up appointments for colorectal cancer patients, we evaluated the effects of surgery with curative intent on the exhaled VOC pattern. This pilot study showed that the VOC pattern changed shortly after surgery, paving the way for use in further clinical trials to address its added value during CRC follow-up appointments, and its ability to detect recurrent disease. ABSTRACT: As current follow-up modalities for colorectal carcinoma (CRC) have restricted sensitivity, novel diagnostic tools are needed. The presence of CRC changes the endogenous metabolism, resulting in the release of a specific volatile organic compounds (VOC) pattern that can be detected with an electronic nose or Aeonose(TM). To evaluate the use of an electronic nose in the follow-up of CRC, we studied the effect of curative surgery on the VOC pattern recognition using Aeonose(TM). A prospective cohort study was performed, in which 47 patients diagnosed with CRC were included, all of whom underwent curative surgical resection. Breath testing was performed before and after surgery using the Aeonose(TM). A machine learning model was developed by discerning between the 94 pre-and postoperative breath samples. The training model differentiated between the pre-and postoperative CRC breath samples with a sensitivity and specificity of 0.78 (95%CI 0.61–0.90) and 0.73 (95%CI 0.56–0.86), respectively, with an accuracy of 0.76 (95%CI 0.66–0.85), and an area under the curve of 0.79 (95%CI 0.68–0.89). The internal validation of the test set resulted in an accuracy of 0.75 (95%CI 0.51–0.91) and AUC of 0.82 (95%CI 0.61–1). In conclusion, our results suggest that the VOC pattern of CRC patients is altered by curative surgery in a short period, indicating that the exhaled VOCs might be closely related to the presence of CRC. However, to use Aeonose(TM) as a potential diagnostic tool in the clinical follow-up of CRC patients, the performance of the models needs to be improved through further large-scale prospective research.