Early ReportVolatile organic compounds in breath as markers of lung cancer: a cross-sectional study
Introduction
Every year, in the USA, 99 000 men and 78 000 women develop lung cancer. 5 years after diagnosis, only 14% of these people are alive. If, however, the lung cancer is localised at the time of diagnosis and treated promptly, 5-year survival increases to 48%.1 This fact has stimulated the search for screening tests to detect lung cancer at an early stage when it is probably localised.
Breath may contain clinically useful markers of lung cancer.2 In 1971, Pauling and co-workers3 reported that normal human breath contains a complex mixture of several hundred volatile organic compounds (VOCs). Since most VOCs are exhaled in picomolar concentrations, special methods are needed to collect and concentrate VOCs before assay. O'Neill and colleagues4, 5 identified 28 breath VOCs as candidate markers of lung cancer—principally alkanes such as hexane and methylpentane, and benzene derivatives. o-toluidine, aniline, and altered lipid-peroxidation activity have also been found in the breath of patients with lung cancer.6, 7
In this study, we studied VOCs in the breath of patients with and without lung cancer.
Section snippets
Methods
In a cross-sectional study, eligible patients were those scheduled for bronchoscopy to investigate a localised chest-radiograph abnormality. Other inclusion criteria were: aged 18 or older, comprehension of the breath-collection procedure, and signed informed consent. Patients with known neoplasms of any kind were excluded. The study was approved by the institutional review boards of Penn State Medical Center, Hammersmith Hospital, and St Vincent's Medical Center.
Bronchoscopy was done by
Results
Between August, 1995, and October, 1996, 108 eligible patients agreed to participate. The collection of breath samples was not associated with any adverse effects. Lung cancer was confirmed histologically in 60 patients (34 men) and excluded in 48 patients (29 men). The mean (SD) age of patients was 66·9 years (12·5) in patients with lung cancer and 61 years (13·4) in patients without. Five patients with lung cancer had never smoked compared with 12 in the group without lung cancer. The
Discussion
The 22 breath VOCs that discriminated between the patients with and without lung cancer were similar to those reported by O'Neill and co-workers4 to be markers of lung cancer. There were some minor differences in chemical structure which might be due to the use of different libraries of mass spectra. Structurally similar breath VOCs were observed in patients with and without lung cancer, but there were significant quantitative differences between the two groups.
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