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Canine scent detection in the diagnosis of lung cancer: revisiting a puzzling phenomenon

R. Ehmann, E. Boedeker, U. Friedrich, J. Sagert, J. Dippon, G. Friedel, T. Walles
European Respiratory Journal 2012 39: 669-676; DOI: 10.1183/09031936.00051711
R. Ehmann
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E. Boedeker
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U. Friedrich
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J. Sagert
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J. Dippon
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G. Friedel
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T. Walles
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  • For correspondence: Thorsten.Walles@klinik-schillerhoehe.de
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  • Figure 1–
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    Figure 1–

    Flow diagram showing the criteria for group assignment and reasons for individuals to be excluded. a) Healthy volunteers tested to be included into group A. b) Patients suspected of having lung cancer on the basis of patient history and pathological imaging to be included into group B after confirmation of the diagnosis by histology. c) Patients treated for chronic obstructive pulmonary disease (COPD) to be included into group C. The flow chart indicates that breath samples were obtained at the beginning of each individual patient evaluation process and were assigned to the respective study groups thereafter. CT: computed tomography.

  • Figure 2–
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    Figure 2–

    Applied methods for breath sampling and testing. a) Glass tube used for breath sampling. The lumen is filled with the polypropylene fleece. b) For breath sampling, study participants exhaled five times through the collection device. c) Test set-up showing the probe retainers. d) The position of the lung cancer samples was randomised. e) Sniffer dogs were trained to identify lung cancer in the breath sample of patients. f) The dogs were trained to indicate a positive test tube by lying on the floor in front of the tube with the muzzle touching the test tube.

  • Figure 3–
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    Figure 3–

    Itemisation of trained and tested tumour stages. a) Early and advanced lung cancer tumour stages were trained and tested. b) Distribution of tested tumour histologies. SCC: squamous cell carcinoma; SCLC: small cell lung cancer.

Tables

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  • Table 1– Breath sample distribution throughout the study
    Group A
    healthy
    Group B
    lung cancer
    Group C
    COPD
    Training6035
    Test I4010
    Test II1040
    Test III10510
    Total1106050
    • Data are presented as n. COPD: chronic obstructive pulmonary disease.

  • Table 2– Composition of training and test groups
    Group A: healthyGroup B: lung cancerGroup C: COPD
    AllTrainingTestp-value#AllTrainingTestp-value#Testp-value¶
    Subjects110605060352550
    Age yrs46.2±14.045.7±12.546.8±15.8ns63.6±10.365.3±9.862.6±11.1ns66.7±6.6<0.001
    Sex M/F26/7428/7224/7678/2271/2988/1256/44
    BMI kg·m−225.3±5.325.2±5.425.4±5.125.4±4.424.9±4.726.1±4.026.5±5.2ns
    Current smoker14 (12.7)9 (15)5 (10.0)13 (21.7)7 (20.0)6 (24.0)13 (26.0)
    History of cancer0 (0)0 (0)0 (0)0 (0)0 (0)0 (0)3 (5)
    Previous surgery0 (0)0 (0)0 (0)0 (0)0 (0)0 (0)1 (1.7)
    Previous intervention0 (0)0 (0)0 (0)34 (57)18 (51)16 (64)0 (0)<0.001
    Sample age days23.6±19.022.3±21.125.2±16.138.5±22.439.4±22.537.3±22.88.1±3.8ns
    • Data are presented as n, mean±sd, %/% or n (%), unless otherwise stated. COPD: chronic obstructive pulmonary disease; M: male; F: female; BMI: body mass index; ns: nonsignificant. #: training versus test; ¶: for comparison of test groups A, B and C.

  • Table 3– Lung function tests in training and test groups
    Group A: healthyGroup B: lung cancerGroup C: COPD
    AllTrainingTestp-value#AllTrainingTestp-value#Testp-value¶
    Subjects110605060352550
    VC L4.0±1.04.1±1.03.8±0.8ns3.5±1.12.9±1.13.5±1.1ns2.8±0.8<0.001
    VC %107±14111±12103±16<0.0183±2179±2283±2179±20
    FEV1 L3.3±0.83.4±0.83.2±0.8ns2.4±0.82.1±1.02.4±0.81.6±0.6
    FEV1 %109±15112±13105±17<0.0574±2573±2576±2561±19
    FEV1 %VC81.2±5.980.6±5.982.0±5.9ns65±1365±1366±1259±11
    TLC L6.0±1.35.9±1.36.0±1.35.8±1.35.9±1.35.8±1.37.1±1.4
    TLC %105±18104±13107±2292±2097±2185±16120±20
    RV L1.8±1.11.6±0.82.1±1.32.5±1.22.7±1.42.1±0.74.4±1.2
    RV %97±5287±30109±69106±49118±5888±25187±56
    GOLD0±0.20±0.20±0.31.1±1.31.2±1.41.1±1.31.9±1.0
    • Data are presented as n or mean±sd, unless otherwise stated. COPD: chronic obstructive pulmonary disease; VC: vital capacity; FEV1: forced expiratory volume in 1 s; TLC: total lung capacity; RV: residual lung volume; GOLD: stage of COPD according to the Global Initiative for Chronic Obstructive Lung Disease; ns: nonsignificant. #: training versus test; ¶: for comparison of test groups A, B and C.

  • Table 4– Cross-tabulation of the dogs’ indication and the presence of cancer
    Breath sample of volunteer without cancer (groups A+C)Breath sample of volunteer with confirmed lung cancer (group B)Total
    Dogs indicating presence of lung cancer287199
    Dogs indicating absence of lung cancer37229401
    Total400100500
    • Data are cumulative results and are presented as n.

  • Table 5– Hit ratio of sniffer dogs
    Dog 1Dog 2Dog 3Dog 4Corporate decision#
    Test I
     Correct7465
     False3645
    Test II
     Correct9878
     False1232
    Test III
     Correct5545
     False0010
    Overall
     Correct21171718
     False4887
    Percentage correct84686872
    Inter-ratervariability κ0.436
    Sensitivity0.72 (0.51–0.88)
    Specificity0.94 (0.87–0.98)
    PPV0.75 (0.53–0.91)
    NPV0.93 (0.86–0.97)
    • Data are presented as n or value (95% confidence interval), unless otherwise stated. PPV: positive predictive value; NPV: negative predictive value. #: at least three dogs alike.

Additional Files

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      Table 6
      Table 7
      Figure 4
  • Supplementary material

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    Files in this Data Supplement:

    • Adobe PDF - Supplementary_material_ERJ-00517-2011.pdf
  • Press release

    Files in this Data Supplement:

    • Press release - Sniffer dogs could be used for the early detection of lung cancer, according to new research published in the European Respiratory Journal.
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Canine scent detection in the diagnosis of lung cancer: revisiting a puzzling phenomenon
R. Ehmann, E. Boedeker, U. Friedrich, J. Sagert, J. Dippon, G. Friedel, T. Walles
European Respiratory Journal Mar 2012, 39 (3) 669-676; DOI: 10.1183/09031936.00051711

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Canine scent detection in the diagnosis of lung cancer: revisiting a puzzling phenomenon
R. Ehmann, E. Boedeker, U. Friedrich, J. Sagert, J. Dippon, G. Friedel, T. Walles
European Respiratory Journal Mar 2012, 39 (3) 669-676; DOI: 10.1183/09031936.00051711
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