An electronic nose distinguishes exhaled breath of patients with Malignant Pleural Mesothelioma from controls

Our plain-English summary of An electronic nose distinguishes exhaled breath of patients with Malignant Pleural Mesothelioma from controls, by S. Dragonieri, M.P. van der Schee, T. Massaro, et al (Lung Cancer, 2012).

The study

• Authors: S. Dragonieri, M.P. van der Schee, T. Massaro, N. Schiavulli, P. Brinkman, A. Pinca, P. Carratú, A. Spanevello, O. Resta, M. Musti, P.J. Sterk
• Journal: Lung Cancer
• Published: 2012;75(3):326-31
• Cited by: 80 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Malignant Pleural Mesothelioma (MPM) is a tumour of the surface cells of the pleura that is highly aggressive and mainly caused by asbestos exposure. Electronic noses capture the spectrum of exhaled volatile organic compounds (VOCs) providing a composite biomarker profile (breathprint).

Objective: We tested the hypothesis that an electronic nose can discriminate exhaled air of patients with MPM from subjects with a similar long-term professional exposure to asbestos without MPM and from healthy controls.

Methods: 13 patients with a histology confirmed diagnosis of MPM (age 60.9±12.2 year), 13 subjects with certified, long-term professional asbestos exposure (age 67.2±9.8), and 13 healthy subjects without asbestos exposure (age 52.2±16.2) participated in a cross-sectional study. Exhaled breath was collected by a previously described method and sampled by an electronic nose (Cyranose 320). Breathprints were analyzed by canonical discriminant analysis on principal component reduction. Cross-validated accuracy (CVA) was calculated.

Results: Breathprints from patients with MPM were separated from subjects with asbestos exposure (CVA: 80.8%, sensitivity 92.3%, specificity 85.7%). MPM was also distinguished from healthy controls (CVA: 84.6%). Repeated measurements confirmed these results.

Conclusions: Molecular pattern recognition of exhaled breath can correctly distinguish patients with MPM from subjects with similar occupational asbestos exposure without MPM and from healthy controls. This suggests that breathprints obtained by electronic nose have diagnostic potential for MPM.

Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

In plain English

This cross-sectional, case-control study tested whether an electronic nose (a handheld device, the Cyranose 320, with 32 chemical sensors) could tell apart the exhaled breath of people with malignant pleural mesothelioma (MPM) from that of other people. It included 39 adults in three groups of 13. The first group had MPM confirmed by tissue examination. The second had long-term certified work exposure to asbestos and pleural plaques and/or benign asbestos pleural effusion, but no MPM. The third was healthy non-smokers with no work exposure to asbestos. Each person gave two breath samples. Against the asbestos-exposed group, the device's pattern analysis classified 80.8% of people correctly, with sensitivity 92.3% and specificity 85.7%. Against the healthy group it classified 84.6% correctly. The second samples gave similar results. The authors noted that the sample was small, that past smoking may have influenced the results, and that the study was too small to compare MPM stages. They concluded that breath patterns from an electronic nose have diagnostic potential for MPM. They said this must next be tested in newly recruited patients who have not already been diagnosed.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Cross-sectional, case-control diagnostic study with two visits; breath sampled in duplicate and analyzed by electronic nose (Cyranose 320)
• Who was studied: 39 adults in 3 groups of 13. Group 1: patients with histology-confirmed MPM not currently treated with chemotherapy or radiotherapy. Group 2: subjects with long-term certified professional asbestos exposure and radiological signs of pleural plaques and/or benign asbestos pleural effusion. Group 3: subjects with no professional asbestos exposure, no smoking history and no known disease. Current smokers were excluded. All were recruited from the same out-patient clinic. The authors' departments were in Bari, Italy. Study dates are not stated.
• Exposure: Long-term occupational asbestos exposure among workers of asbestos-cement factories and asbestos mines in a narrow geographical area. No fiber type or dose is given. The test studied was exhaled-breath profiling by electronic nose.
• Main results:
  • MPM patients versus asbestos-exposed subjects without MPM: cross-validated accuracy 80.8% (p less than 0.001)
  • MPM versus asbestos-exposed: area under the ROC curve 0.917. At a cut-off of 0.33, sensitivity was 92.3% and specificity 85.7%, with positive and negative predictive values of 0.83 and 0.78.
  • MPM versus asbestos-exposed, second breath bag: cross-validated accuracy 88.5%, sensitivity 100%, specificity 84.6%
  • MPM patients versus healthy controls: cross-validated accuracy 84.6% (p less than 0.001), area under the ROC curve 0.893
  • MPM versus healthy controls at a cut-off of 0.31: sensitivity 92.3% and specificity 69.2%, with positive and negative predictive values printed as 0.91 and 0.80
  • MPM versus healthy controls, second breath bag: cross-validated accuracy 88.5%, sensitivity 92.3%, specificity 92.3%
  • Three-way classification (MPM, asbestos-exposed, healthy controls): cross-validated accuracy 79.5% (p = 0.001), area under the ROC curve 0.885
  • Internal validation by bootstrapping: MPM versus asbestos-exposed accuracy 82.9% (p less than 0.05), area under the curve 0.88. MPM versus healthy controls accuracy 85.0%, area under the curve 0.83.
  • Of the 13 MPM patients, 8 had tumour confined to the pleural surface (stages Ia to Ib) and 5 had locally advanced disease (stages II to III)
• The authors' conclusion: The authors concluded that breathprints obtained by electronic nose have diagnostic potential for MPM. They said their results warrant external validation, since this study provides only a training set with internal validation.
• Limitations the authors state:
  • The sample size was relatively limited, which the authors attribute to MPM being a rare tumour
  • Ex-smokers were included in the MPM and exposed groups, and the authors could not exclude that past smoking influenced the results
  • The sample was too small to distinguish different stages of MPM
  • Patients were already diagnosed. Future studies should include newly recruited patients who have not been diagnosed in advance.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Pleura, Asbestos Exposure, Biomarker, Histology.

Related studies

• A breath test for malignant mesothelioma using an electronic nose — E.A. Chapman, P.S. Thomas, et al. (2012)
• Chemical characterization of exhaled breath to differentiate between patients with malignant plueral mesothelioma from subjects with similar professional asbestos exposure — G. de Gennaro, S. Dragonieri, et al. (2010)
• Breath analysis by gas chromatography-mass spectrometry and electronic nose to screen for pleural mesothelioma: a cross-sectional case-control study — K. Lamote, P. Brinkman, et al. (2017)
• Exhaled breath to screen for malignant pleural mesothelioma: a validation study — K. Lamote, M. Vynck, et al. (2017)
• Use of exhaled breath condensate to investigate occupational lung diseases — M. Corradi, P. Gergelova, et al. (2010)
• Detection of malignant pleural mesothelioma in exhaled breath by multicapillary column/ion mobility spectrometry (MCC/IMS) — K. Lamote, M. Vynck, et al. (2016)

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