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Colorectal Cancer Screening with Odour Material by Canine Scent Gut Online First, published on January 31, 2011 as 10.1136/gut.2010.218305 Colon Colorectal cancer screening with odour material by Gut: first published as 10.1136/gut.2010.218305 on 31 January 2011. Downloaded from canine scent detection Hideto Sonoda,1,6 Shunji Kohnoe,1,6 Tetsuro Yamazato,2 Yuji Satoh,3 Gouki Morizono,4 Kentaro Shikata,5 Makoto Morita,6 Akihiro Watanabe,6 Masaru Morita,1 Yoshihiro Kakeji,1 Fumio Inoue,4 Yoshihiko Maehara1 1Department of Surgery and ABSTRACT Science, Kyushu University at Objective Early detection and early treatment are of vital Significance of this study Fukuoka, Fukuoka, Japan importance to the successful treatment of various 2Department of Internal cancers. The development of a novel screening method Medicine, Arita Kyoritsu What is already known about this subject? Hospital at Arita, Saga, Japan that is as economical and non-invasive as the faecal < 3 Canine olfactory detection of cancer has been St. Sugar Cancer Sniffing Dog occult blood test (FOBT) for early detection of colorectal reported for melanoma as well as bladder, lung, Training Center at cancer (CRC) is needed. A study was undertaken using Minamibousou, Chiba, Japan breast and ovarian cancer. 4 canine scent detection to determine whether odour Department of General < It is reported that dogs can be trained to material can become an effective tool in CRC screening. Surgery, Arita Kyoritsu Hospital distinguish breath samples of patients with lung at Arita, Saga, Japan Design Exhaled breath and watery stool samples were 5 and breast cancer from those of control Department of Internal obtained from patients with CRC and from healthy volunteers and to distinguish ovarian cancer Medicine, Fukuoka Dental controls prior to colonoscopy. Each test group consisted College Hospital at Fukuoka, tissues from control tissues with high accuracy. of one sample from a patient with CRC and four control Fukuoka, Japan < Several volatile organic compounds have been 6 samples from volunteers without cancer. These five Department of General identified as candidate substances for early Surgery, Fukuoka Dental College samples were randomly and separately placed into five detection of cancer using gas chromatography/ Hospital at Fukuoka, Fukuoka, boxes. A Labrador retriever specially trained in scent Japan mass spectroscopy in the exhaled breath of detection of cancer and a handler cooperated in the patients with lung and breast cancer; while tests. The dog first smelled a standard breath sample Correspondence to these data are promising, they are preliminary Dr Hideto Sonoda, Department from a patient with CRC, then smelled each sample findings that should be interpreted with caution. of Surgery and Science station and sat down in front of the station in which Graduate School of Medicine a cancer scent was detected. Kyushu University 3-1-1 What are the new findings? < Midashi,Higashi-ku, Fukuoka Results 33 and 37 groups of breath and watery stool In patients with colorectal cancer (CRC) and 812-8582, Japan; hsonoda@ samples, respectively, were tested. Among patients with controls, the sensitivity of canine scent detec- http://gut.bmj.com/ surg2.med.kyushu-u.ac.jp CRC and controls, the sensitivity of canine scent tion of breath samples compared with conven- detection of breath samples compared with conventional tional diagnosis by colonoscopy was 0.91 and Revised 23 November 2010 diagnosis by colonoscopy was 0.91 and the specificity Accepted 7 December 2010 the specificity was 0.99. was 0.99. The sensitivity of canine scent detection of < The sensitivity of canine scent detection of stool samples was 0.97 and the specificity was 0.99. watery stool samples was 0.97 and the The accuracy of canine scent detection was high even specificity was 0.99. < for early cancer. Canine scent detection was not The accuracy of canine scent detection was on September 26, 2021 by guest. Protected copyright. confounded by current smoking, benign colorectal even higher for early-stage cancers. disease or inflammatory disease. < Canine scent detection was not confounded by Conclusions This study shows that a specific cancer current smoking, benign colorectal disease, scent does indeed exist and that cancer-specific inflammatory disease or the presence of chemical compounds may be circulating throughout the human haemoglobin or transferrin. body. These odour materials may become effective tools in CRC screening. In the future, studies designed to How might it impact on clinical practice in the identify cancer-specific volatile organic compounds will foreseeable future? be important for the development of new methods for < Odour materials may become effective tools in early detection of CRC. CRC screening. In the future, studies designed to identify cancer-specific volatile organic compounds will be important for the develop- ment of new methods for early detection of INTRODUCTION CRC. Despite rapid progress in examination technology < Identification of cancer-specific volatile organic and therapy for colorectal cancer (CRC), this compounds will lead to solving the biological disease constitutes a significant proportion of the character of cancer. global burden of cancer morbidity and mortality.1 Multiple professional organisations have recom- e mended screening for CRC1 5 and many previous This paper is freely available studies have demonstrated the cost-effectiveness of to reduce the morbidity and mortality associated online under the BMJ Journals 6e11 12e15 unlocked scheme, see http:// CRC screening. Moreover, patients with with CRC. Early detection and early treat- gut.bmj.com/site/about/ familial adenomatous polyposis or Lynch syndrome ment are critical for the successful treatment of unlocked.xhtml are recommended to undergo frequent colonoscopy cancer and are excellent means for reducing both CopyrightSonoda H, Kohnoe Article S, Yamazato author T, et(or al. theirGut (2011). employer) doi:10.1136/gut.2010.218305 2011. Produced by BMJ Publishing Group Ltd (& BSG) under licence. 1 of 6 Colon the economic burden and mortality. CRC therefore represents an Company, Tokyo, Japan) between the rectum and descending excellent example of the value of early detection. colon and preserved at À808C until filtration. The sample was Gut: first published as 10.1136/gut.2010.218305 on 31 January 2011. Downloaded from The faecal occult blood test (FOBT) is currently the most filtered with qualitative filter paper No. 2 (diameter 110 mm; economic and non-invasive screening method for CRC, and Tokyo Roshi Kaisha, Tokyo, Japan) and further filtered by Millex many patients with positive results subsequently undergo total GP filter (pore size 0.22 mm, diameter 33 mm, non-sterile type; colonoscopy leading to a reduced incidence and mortality of Millipore Co, Corrigiwohill, Co. Cork, Ireland). Next, 1 ml of CRC.2 3616However, the positive predictive value of FOBT for filtrated watery stool samples was enclosed in a 5 ml brown e CRC is approximately 10%,17 20 16 21 considering the impact of glass screw cap bottle, sealed in an ordinary grocery store small closer examination by colonoscopy or barium enema. The devel- Ziploc-style bag and enclosed in a 50 ml polypropylene screw opment of a novel more effective CRC screening method that is cap tube and kept at À208C until presentation to the dog. Only as economical and non-invasive as FOBT is therefore needed. one sample was collected from each participant. There have been several anecdotal reports of canine scent detection of skin cancer.22 23 Moreover, Willis et al reported that Dog and training dogs can distinguish urine from patients with bladder cancer A specially trained 8-year-old female black Labrador retriever with a mean success rate of 41%,24 while McCulloch et al from the St Sugar Cancer Sniffing Dog Training Center (Chiba, reported that ordinary household dogs can be trained to distin- Japan) participated in the study. The dog was trained for water guish breath samples of patients with lung and breast cancer rescue beginning in 2003 and then began training as a cancer from those of control volunteers with high accuracy (sensitivity detection dog in 2005. and specificity of 0.99 and 0.99 in lung cancer and 0.88 and 0.98 Each cancer detection training session was considered in breast cancer, respectively).25 Horvath et al reported that, complete when the dog could correctly distinguish between among ovarian cancer tissues and control tissues, the sensitivity breath samples from a cancer patient and four controls consec- was 100% and the specificity was 97.5%.26 utively in dozens of trials. The fundamental training method In the present study we have confirmed the accuracy of canine was a reward-based approach in which the correct behaviour is scent detection of breath samples and evaluated canine scent rewarded by simultaneous play with a tennis ball. The breath detection of watery stool samples from patients with CRC. We samples used in the training steps beginning in 2005 were also examined whether the diagnostic performance of dogs is collected from several hundred patients with cancer and about affected by age, smoking, disease stage, cancer site, inflamma- 500 healthy volunteers recruited using the internet. tion or bleeding in patients with cancer or control individuals. In the first training step in 2005, breath samples from one patient with oesophageal cancer and four controls were used. METHODS The samples were removed from the breath-sampling bag and Patient and control sample donors placed into a paper cup which was then covered with a paper fi fi fl Patients were enrolled from 20 June 2008 to 20 May 2009 at the lter for 2 days. The ve sample cups were placed on the oor by Fukuoka Dental College Medical and Dental Hospital and Arita the handler. First, the dog smelled the standard breath sample Kyoritsu Hospital. To prepare for colonoscopy, subjects ingested from the patient with oesophageal cancer and then tried to http://gut.bmj.com/ 2 l of a balanced electrolyte and polyethylene glycol 4000 solu- identify the cup containing the oesophageal cancer scent from tion (Niflec, Ajinomoto Pharma, Tokyo, Japan).
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