Breath analysis by gas chromatography-mass spectrometry can be used to screen for pleural mesothelioma

Background Malignant pleural mesothelioma (MPM) is an asbestos-related tumour with poor prognosis. It is thought that only an early diagnosis will improve patient9s outcome. Breathomics allows to detect breath volatile organic compounds (VOCs) which can be used as non-invasive markers for disease. Aim To identify VOCs in breath with gas chromatography-mass spectrometry (GC-MS) for MPM screening. Methods We included 14 MPM patients, 18 asymptomatic asbestos-exposed persons, 16 patients with benign asbestos-related diseases and 14 healthy non-exposed persons. After 2 hours of fasting, subjects breathed tidally for 5 minutes through a VOC filter. Next, a full vital capacity was sampled in a Tedlar bag of which 500 ml was transferred on a Tenax GR -column. Samples were thermally desorbed and analysed by GC-MS (Agilent 6890A–Thermo Focus DSQII). VOCs with S/Nu003e10 were manually selected and standardised to an internal standard. We looked for significant VOC differences and constructed ROC-curves for discriminating MPM from all control groups. Results 114 VOCs were selected. 17 were significantly different between MPM patients and controls. Of these, 7 had an AUCu003e0.8 and are possible markers for MPM screening. Conclusion The good sensitivity and specificity allows to screen at-risk persons for MPM using breath. Future work includes combining models for discrimination and their validation using external standards.