Breath analysis as a diagnostic and screening tool for malignant pleural mesothelioma: a systematic review

Abstract

Malignant pleural mesothelioma (MPM) is a tumour related to a historical exposure to asbestos fibres. Currently, the definite diagnosis is made only by the histological examination of a biopsy obtained through an invasive thoracoscopy. However, diagnosis is made too late for curative treatment because of non-specific symptoms mainly appearing at advanced stage disease. Hence, due to its biologic aggressiveness and the late diagnosis, survival rate is low and the patients' outcome poor. In addition, radiological imaging, like computed tomographic scans, and blood biomarkers are found not to be sensitive enough to be used as an early diagnostic tool. Detection in an early stage is assumed to improve the patients' outcome but is hampered due to non-specific and late symptomology. Hence, there is a need for a new screening and diagnostic test which could improve the patients' outcome. Despite extensive research has focused on blood biomarkers, not a single has been shown clinically useful, and therefore research recently shifted to "breathomics" techniques to recognize specific volatile organic compounds (VOCs) in the breath of the patient as potential non-invasive biomarkers for disease. In this review, we summarize the acquired knowledge about using breath analysis for diagnosing and monitoring MPM and asbestos-related disorders (ARD). Gas chromatography-mass spectrometry (GC-MS), the gold standard of breath analysis, appears to be the method with the highest accuracy (97%) to differentiate MPM patients from at risk asbestosexposed subjects. There have already been found some interesting biomarkers that are significantly elevated in asbestosis (NO, 8-isoprostane, leukotriene B4, α-Pinene…) and MPM (cyclohexane) patients. Regrettably, the different techniques and the plethora of studies suffer some limitations. Most studies are pilot studies with the inclusion of a limited number of patients. Nevertheless, given the promising results and easy sampling methods, we can conclude that breath analysis may become a useful tool in the future to screen for MPM, but further research is warranted.

Breath Analysis for Early Detection of Malignant Pleural Mesothelioma: Volatile Organic Compounds (VOCs) Determination and Possible Biochemical Pathways

“…VOCs deriving from these biological processes could be transported through the bloodstream to the lungs, where they enter the alveoli by the alveolar gas exchange mechanism and thus, are exhaled in the breath. Therefore, VOCs profile in breath may reflect changes in the subject's health status [13][14][15].…”

A Literature Review of the Potential Diagnostic Biomarkers of Head and Neck Neoplasms

“…This encompasses volatile organic compounds (VOCs) in nano- to picomolar concentrations, which are the gaseous end products from endogenous metabolic changes, digestion, microbiome, inflammation, and oxidative stress. VOCs can be detected in breath, urine, feces, blood, saliva, skin, and sweat, and hence, serve as attractive biomarkers, as it is completely non-invasive, relatively cheap, and provides rapid results ( 78 ). VOCs have already shown clinical potential as biomarkers for lung ( 79 ), gastric ( 80 ), breast ( 81 ), prostate ( 82 ), and mesothelioma cancer ( 83 ), and since carcinogenesis is related to inflammation and metabolic changes, VOCs could also have added value as diagnostic biomarkers for head and neck cancer ( Table 5 ).…”

Hyperspectral Imaging and Hierarchical PLS-DA Applied to Asbestos Recognition in Construction and Demolition Waste

“…MPM is a rare, aggressive tumor. It originates from the serosal cells lining the lungs and according to the World Health Organization (WHO), mesothelioma, asbestos-related lung cancer and asbestosis globally cause 107,000 deaths annually [6]. Human health can be damaged by inhaling fibers when they become airborne due to weathering or human activities producing dust [7].…”