Exhaled breath to screen for malignant pleural mesothelioma: a validation study

Abstract

Malignant pleural mesothelioma (MPM) is predominantly caused by asbestos exposure and has a poor prognosis. Breath contains volatile organic compounds (VOCs) and can be explored as an early detection tool. Previously, we used multicapillary column/ion mobility spectrometry (MCC/IMS) to discriminate between patients with MPM and asymptomatic high-risk persons with a high rate of accuracy. Here, we aim to validate these findings in different control groups.Breath and background samples were obtained from 52 patients with MPM, 52 healthy controls without asbestos exposure (HC), 59 asymptomatic former asbestos workers (AEx), 41 patients with benign asbestos-related diseases (ARD), 70 patients with benign non-asbestos-related lung diseases (BLD) and 56 patients with lung cancer (LC).After background correction, logistic lasso regression and receiver operating characteristic (ROC) analysis, the MPM group was discriminated from the HC, AEx, ARD, BLD and LC groups with 65%, 88%, 82%, 80% and 72% accuracy, respectively. Combining AEx and ARD patients resulted in 94% sensitivity and 96% negative predictive value (NPV). The most important VOCs selected were P1, P3, P7, P9, P21 and P26.We discriminated MPM patients from at-risk subjects with great accuracy. The high sensitivity and NPV allow breath analysis to be used as a screening tool for ruling out MPM.

The electronic nose: emerging biomarkers in lung cancer diagnostics

“…The first tests were published in 2012 [30,31], showing that molecular pattern recognition of exhaled breath could distinguish mesothelioma patients from healthy controls. More recently, this was confirmed by a study combining breath analysis by gas chromatography-mass spectrometry and an e-nose [32,33].…”

Exhaled Breath Analysis in Diagnosis of Malignant Pleural Mesothelioma: Systematic Review

“…The remaining eight studies did not cover MPM patients, although they assessed exhaled breath analysis of asbestos related diseases. Six studies [69][70][71][72][73][74] were eventually included in the review. An overview of the study selection steps is presented in Figure 3.…”

“…Representative samples of MPM cases were recruited from respiratory and occupational medicine departments of several hospitals, in all the studies. Control groups were selected from volunteers working at hospitals [69,70], from the patients visiting outpatient settings [72][73][74] or from community volunteers [71]. Cases and controls were matched for age, sex and smoking status in one study [71].…”

“…Three studies excluded subjects with any systemic disease or respiratory infection [69][70][71]. Information regarding asbestos exposure of MPM cases were obtained through self-reports [69,70] or questionnaires [71][72][73][74] while that of asbestos exposed control groups were mainly retrieved from company records [69,70,[72][73][74]. However, none of the studies obtained asbestos exposure information through structured exposure assessment tools nor accounted for duration of asbestos exposure.…”

“…All studies were of a cross-sectional, case-control design, published between 2010 and 2017, and explored VOC-based exhaled breath profile in MPM patients using analytical or sensor-based technologies. Four studies [71][72][73][74] were conducted at more than one center. The number of MPM cases varied between 13 and 52 across studies.…”