Strengths, weaknesses, and opportunities of diagnostic breathomics in pleural mesothelioma-a hypothesis

Our plain-English summary of Strengths, weaknesses, and opportunities of diagnostic breathomics in pleural mesothelioma-a hypothesis, by K. Lamote, K. Nackaerts, J.P. van Meerbeeck (Cancer Epidemiology, Biomarkers & Prevention, 2014).

The study

• Authors: K. Lamote, K. Nackaerts, J.P. van Meerbeeck
• Journal: Cancer Epidemiology, Biomarkers & Prevention
• Published: 2014;23(6):898-908
• Cited by: 19 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Past and present asbestos use will reflect in increasing numbers of mesothelioma cases in the next decades, diagnosed at a late stage and with a dismal prognosis. This stresses the need for early detection tools, which could improve patients' survival. Recently, breath analysis as a noninvasive and fast diagnostic tool has found its way into biomedical research. High-throughput breathomics uses spectrometric, chromatographic, and sensor techniques to diagnose asbestos-related pulmonary diseases based upon volatile organic compounds (VOC) in breath. This article reviews the state-of-the-art available breath analyzing techniques and provides the insight in the current use of VOCs as early diagnostic or prognostic biomarkers of mesothelioma to stimulate further research in this field. Cancer Epidemiol Biomarkers Prev; 23(6); 898-908. ©2014 AACR.

©2014 American Association for Cancer Research.

In plain English

This article is a review, labelled a hypothesis/commentary. The authors searched MEDLINE (PubMed) and Web of Science up to December 2013 for studies of exhaled breath testing in asbestos-related lung and pleural diseases, considering only English-language literature on human material. They described several breath-testing techniques: exhaled breath condensate, exhaled nitric oxide, gas chromatography-mass spectrometry, ion mobility spectrometry, electronic noses and trained dogs. The results they reported come from other studies. In one group's gas chromatography study of 13 patients with malignant pleural mesothelioma, 13 healthy asbestos-exposed people and 13 healthy controls, a model told the groups apart with 97% accuracy. Several of the breath compounds involved were also found in lung cancer. Two electronic-nose studies separated mesothelioma patients from controls with sensitivities of 92% and 90%. No breath condensate or dog studies of mesothelioma were reported. The authors stated that differences between studies made it hard to draw clinically relevant conclusions. They concluded that breath analysis will eventually become useful for diagnosing asbestos-related diseases, and they called for large prospective studies and standardized sampling.

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: Narrative literature review (published as a hypothesis/commentary) of breath analysis techniques in asbestos-related diseases and malignant pleural mesothelioma
• Who was studied: Published studies of exhaled breath research in asbestos-related pulmonary diseases up to December 2013, limited to English-language literature on human material. 131 publications were selected, plus 21 more found through their reference lists.
• Exposure: Asbestos exposure in general (no specific fiber types analysed). The techniques reviewed were exhaled breath condensate, exhaled nitric oxide, gas chromatography-mass spectrometry, ion mobility spectrometry, electronic noses and canine scent.
• Main results:
  • Earlier studies found oxidative markers in exhaled breath condensate increased in asbestos-exposed people or patients with asbestos-related diseases compared with healthy controls. No such measurements had been made for mesothelioma specifically.
  • One cited group's gas chromatography-mass spectrometry study (13 patients with malignant pleural mesothelioma, 13 healthy asbestos-exposed individuals, 13 healthy controls) found higher cyclohexane in the mesothelioma patients' breath. A model built from it distinguished the groups with 97% accuracy.
  • Cyclohexane and several other breath compounds were also found in patients with lung cancer. The authors therefore said these compounds lack specificity for mesothelioma.
  • In a cited electronic-nose study, 13 mesothelioma patients were distinguished from 13 asbestos-exposed individuals and 13 healthy controls with 92% sensitivity, and specificities printed as 86% and 69%.
  • In a repeat electronic-nose study, 20 mesothelioma patients were distinguished from 18 asbestos-exposed and 42 healthy individuals with 90% sensitivity and 88% specificity.
  • No canine scent studies for asbestosis or mesothelioma were available.
  • The authors described gas chromatography-mass spectrometry as the gold standard because it is very sensitive. They also noted it is very expensive, time-consuming and laborious.
• The authors' conclusion: The authors concluded that breath analysis will eventually become a useful tool for diagnosing asbestos-related diseases, but that the way to a validated, clinically implemented model is still difficult. They called for a large prospective case-control study with suitable control groups and standardized sampling.
• Limitations the authors state:
  • The published studies varied in sample size, design, control groups, techniques, sampling and data analysis, which makes comparison and clinically relevant conclusions difficult.
  • Offline sampling methods carry a risk of sample contamination, which could bias comparisons between research groups.
  • The possible role of exhaled nitric oxide in early mesothelioma diagnosis had not been investigated.

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, Mesothelioma, Prognosis, Biomarker.

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