Breath analysis by gas chromatography-mass spectrometry and electronic nose to screen for pleural mesothelioma: a cross-sectional case-control study
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Kevin Lamote1,2, Paul Brinkman3, Lore Vandermeersch4, Matthijs Vynck5, Peter J. Sterk3, Herman Van Langenhove4, Olivier Thas5, Joris Van Cleemput6, Kristiaan Nackaerts7 and Jan P. van Meerbeeck2,8
1Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
2Department of Internal Medicine, Ghent University, Ghent, Belgium
3Department of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
4Department of Sustainable Organic Chemistry and Technology, EnVOC Research Group, Ghent University, Ghent, Belgium
5Department of Mathematical Modelling, Statistics and Bio-Informatics, Ghent University, Ghent, Belgium
6Occupational Health Service, Eternit N.V., Kapelle-op-den-Bos, Belgium
7Department of Respiratory Diseases, KU Leuven, University Hospitals Leuven, Leuven, Belgium
8Thoracic Oncology/MOCA, Antwerp University Hospital, Edegem, Belgium
Kevin Lamote, email: [email protected]
Keywords: mesothelioma, breath tests, volatile organic compounds, gas chromatography-mass spectrometry, electronic nose
Received: October 25, 2016 Accepted: July 16, 2017 Published: September 27, 2017
Rationale: Malignant pleural mesothelioma (MPM) is mainly caused by previous exposure to asbestos fibers and has a poor prognosis. Due to a long latency period between exposure and diagnosis, MPM incidence is expected to peak between 2020-2025. Screening of asbestos-exposed individuals is believed to improve early detection and hence, MPM management. Recent developments focus on breath analysis for screening since breath contains volatile organic compounds (VOCs) which reflect the cell’s metabolism.
Objectives: The goal of this cross-sectional, case-control study is to identify VOCs in exhaled breath of MPM patients with gas chromatography-mass spectrometry (GC-MS) and to assess breath analysis to screen for MPM using an electronic nose (eNose).
Methods: Breath and background samples were taken from 64 subjects: 16 healthy controls (HC), 19 asymptomatic former asbestos-exposed (AEx) individuals, 15 patients with benign asbestos-related diseases (ARD) and 14 MPM patients. Samples were analyzed with both GC-MS and eNose.
Results: Using GC-MS, AEx individuals were discriminated from MPM patients with 97% accuracy, with diethyl ether, limonene, nonanal, methylcyclopentane and cyclohexane as important VOCs. This was validated by eNose analysis. MPM patients were discriminated from AEx+ARD participants by GC-MS and eNose with 94% and 74% accuracy, respectively. The sensitivity, specificity, positive and negative predictive values were 100%, 91%, 82%, 100% for GC-MS and 82%, 55%, 82%, 55% for eNose, respectively.
Conclusion: This study shows accurate discrimination of patients with MPM from asymptomatic asbestos-exposed persons at risk by GC-MS and eNose analysis of exhaled VOCs and provides proof-of-principle of breath analysis for MPM screening.
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