Lung cancer breath analysis Part1

Cancer develops over a long period and results in a diverse and complex tumour environment. Lung cancer is the leading cause of cancer death worldwide. The reason is not its aggressive biology but late-stage detection. An initial clinical solution for lung cancer screening is low-dose computed tomography (CT). However, further innovations and refinements would help to address its limitations. The non-invasive, convenient and fast nature of breath analysis makes this technology highly attractive to supplement low-dose CT. However, breath analysis has not yet been adopted in everyday clinical practice. One major reason might be the variety of breath analytical methods. The recent ELCABA scoping review provides a comprehensive summary of study designs, breath analytical methods and putative biomarkers in lung cancer breath analysis.

Figure 1: Modern breath analysis is a complex and sensitive approach to gain new insights into lung cancer disease. Because of the technological infrastructure requirements, lung cancer breath research is concentrated in innovation hot spots and technically developed centres. The dots indicate the locations of research groups conducting lung cancer breath analysis studies. These studies have been conducted in clinical settings with volunteering participants. Many different breath analysis methods were used, which underlines the heterogeneity of modern breath analysis approaches.

The origin of putative lung cancer breath biomarkers

Most lung cancer patients show genetic and metabolic aberrations represented by biological messengers (putative biomarkers). If such messengers can pass the blood–air barrier, breath analysis can detect lung cancer clues. The origins of these putative breath markers are diverse, and possible sources include:

• Lipid peroxidation of cell membrane elements due to cell death
• Inflammatory processes
• Metabolites from uncontrolled cell proliferation and metabolism
• Genetic and epigenetic changes.

Innovative breath analysis technologies to detect lung cancer

Since the 1980s, different methods have been developed to identify lung cancer–specific breath biomarkers. Exhaled breath can be analysed online or offline. Online, or real-time, describes the direct measurement and analysis of exhaled air. This is a smart procedure where a person exhales directly into an analytical device, and the results are available immediately. In contrast, offline describes the analysis of previously collected exhaled breath or exhaled breath condensate.

Online and offline breath measurements are extremely different and show different advantages and disadvantages. To explain offline analysis more precisely, a breath sample must be trapped in a sampling container and then analysed. Exhaled breath collected offline can be analysed in two ways: as exhaled breath in a gas matrix or as exhaled breath condensate in a liquid matrix. Notably, each breath sample comprises a different spectrum of exhaled compounds and provides different biological information. Online breath analysis shows many advantages compared to offline measurements. The most relevant is a fast result for clinical interpretation. Furthermore, online measurements need no sample preparation, storage or logistics, which are well-described sources of confounding factors.

We at DBI support research exploring the early diagnosis of lung cancer using state-of-the-art breath analysis. Being able to diagnose this disease early would dramatically increase the survival rate. Learn more about DBI’s technology & solution.

See the following video about breath research: