Detection of malignant pleural mesothelioma in exhaled breath by multicapillary column/ion mobility spectrometry (MCC/IMS)

Our plain-English summary of Detection of malignant pleural mesothelioma in exhaled breath by multicapillary column/ion mobility spectrometry (MCC/IMS), by K. Lamote, M. Vynck, J. Van Cleemput, et al (Journal of Breath Research, 2016).

The study

• Authors: K. Lamote, M. Vynck, J. Van Cleemput, O. Thas, K. Nackaerts, J.P. van Meerbeeck
• Journal: Journal of Breath Research
• Published: 2016;10(4):046001
• Cited by: 28 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant pleural mesothelioma (MPM) is predominantly caused by previous asbestos exposure. Diagnosis often happens in advanced stages restricting any therapeutic perspectives. Early stage detection via breath analysis was explored using multicapillary column/ion mobility spectrometry (MCC/IMS) to detect volatile organic compounds (VOCs) in the exhaled breath of MPM patients in comparison to former occupational asbestos-exposed and non-exposed controls. Breath and background samples of 23 MPM patients, 22 asymptomatic former asbestos (AEx) workers and 21 healthy non-asbestos exposed persons were taken for analysis. After background correction, we performed a logistic least absolute shrinkage and selection operator (lasso) regression to select the most important VOCs, followed by receiver operating characteristic (ROC) analysis. MPM patients were discriminated from both controls with 87% sensitivity, 70% specificity and respective positive and negative predictive values of 61% and 91%. The overall accuracy was 76% and the area under the ROC-curve was 0.81. AEx individuals could be discriminated from MPM patients with 87% sensitivity, 86% specificity and respective positive and negative predictive values of 87% and 86%. The overall accuracy was 87% with an area under the ROC-curve of 0.86. Breath analysis by MCC/IMS allows MPM patients to be discriminated from controls and holds promise for further investigation as a screening tool for former asbestos-exposed persons at risk of developing MPM.

In plain English

This Belgian multicentre case-control study tested whether a breath-analysis device (MCC/IMS) could distinguish people with malignant pleural mesothelioma (MPM) from others. Breath was sampled from 23 MPM patients before any treatment, 22 asymptomatic former workers from a fibre-cement factory that used asbestos until 1997, and 21 healthy people without asbestos exposure. Of the MPM patients, 61% had occupational asbestos exposure. The authors measured 89 volatile compounds and built a statistical model. They checked it by leave-one-out cross-validation on the same participants rather than on a separate group. Separating MPM patients from both control groups combined gave 87% sensitivity (95% confidence interval 69% to 97%), 70% specificity (55% to 82%) and an area under the curve of 0.81 (0.69 to 0.91). Against the former asbestos workers alone, sensitivity was 87% (69% to 97%) and specificity 86% (67% to 96%). Four compounds mattered most, and none has yet been chemically identified. The authors concluded that the breath test was feasible and could hold promise for screening. They noted that the groups were small, were not age-matched and differed in smoking, and that larger studies including other lung diseases are needed.

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: Multicentre, cross-sectional, case-control study of exhaled breath analysed by MCC/IMS, with lasso logistic regression and leave-one-out cross-validation
• Who was studied: 66 participants in Belgium: 23 treatment-naïve MPM patients, 22 asymptomatic former asbestos workers (AEx) and 21 healthy non-asbestos-exposed controls (HC), all without comorbidities; breath sampled between 1 January 2012 and 20 December 2014
• Exposure: Occupational asbestos exposure (fiber type not specified). The former workers came from a fibre-cement factory that used asbestos until 1997. All AEx persons, no HC persons and 61% of MPM patients had occupational asbestos exposure.
• Main results:
  • MPM patients versus pooled AEx and HC controls, model including the 89 volatile compounds: sensitivity 87% (69%–97%), PPV 61% (43%–76%), NPV 91% (77%–98%), specificity 70% (55%–82%)
  • MPM patients versus pooled controls: area under the ROC curve 0.81 (0.69–0.91)
  • MPM patients versus pooled controls using only gender and smoking status, without the breath compounds: diagnostic accuracy 62% (50%–73%)
  • MPM patients versus former asbestos workers (AEx): sensitivity 87% (69%–97%), specificity 86% (67%–96%), PPV 87%, NPV 86%, AUC 0.86 (0.74–0.94 in the text)
  • AEx persons versus healthy controls: accuracy 91% (79%–97%), sensitivity 95% (80%–100%), specificity 86% (66%–96%)
  • Healthy controls versus MPM patients: accuracy 82% (68%–91%), AUC 0.74 in the text (0.73 in Table 3), sensitivity 96% (80%–100%), specificity 67% (45%–84%)
  • Four unidentified compounds (P3, P5, P50, P71) were the most important features separating MPM patients from both control groups
  • MPM patients were older (median 66 years) than AEx persons (median 56 years)
• The authors' conclusion: The authors concluded that they had shown the feasibility of an easy breath test using MCC/IMS to discriminate MPM patients from people with and without occupational asbestos exposure. They said it could hold promise for screening, but should be validated in a larger population and compared with other lung diseases before clinical use.
• Limitations the authors state:
  • Participant numbers are too low to extrapolate the results to the whole at-risk population
  • External validation is needed in an independent set that also includes patients with lung cancer and benign asbestos-related diseases
  • Groups were not age-matched and differed in smoking status; age was not included as a predictor
  • Background correction may not fully remove environmental compounds
  • The sampling line was unheated, so some compounds may have been lost
  • The key compounds could not be identified, and without GC-MS data they may be co-eluting compounds or related forms of one molecule

Topics

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

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

Related studies

• Exhaled breath to screen for malignant pleural mesothelioma: a validation study — K. Lamote, M. Vynck, et al. (2017)
• Exhaled Breath Analysis in Diagnosis of Malignant Pleural Mesothelioma: Systematic Review — Z.N. Töreyin, M. Ghosh, et al. (2020)
• 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)
• An electronic nose distinguishes exhaled breath of patients with Malignant Pleural Mesothelioma from controls — S. Dragonieri, M.P. van der Schee, et al. (2012)
• Use of exhaled breath condensate to investigate occupational lung diseases — M. Corradi, P. Gergelova, et al. (2010)
• Leukotrienes B4, C4, D4 and E4 in the exhaled breath condensate (EBC), blood and urine in patients with pneumoconiosis — D. Pelclová, Z. Fenclová, et al. (2012)

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