Exhaled breath analysis allows exclusive screening for malignant pleural mesothelioma

Rationale: Malignant Pleural Mesothelioma (MPM) is predominantly caused by previous asbestos exposure and is characterised by a poor prognosis. Breath contains volatile organic compounds (VOCs) and can be explored as early detection tool. Using multi-capillary column/ion mobility spectrometry (MCC/IMS), we previously discriminated MPM patients from asymptomatic high-risk persons. Our aim is to validate these findings by including more patients and different control groups. Methods: Breath and background samples of 52 MPM patients, 59 asymptomatic former asbestos (AEx) workers, 52 healthy non-asbestos exposed (HC) persons, 41 patients with benign asbestos-related diseases (ARD), 70 patients with benign non-asbestos-related lung diseases (BLD) and 56 lung cancer (LC) patients were taken for analysis. After background correction, we performed a logistic lasso regression, followed by ROC analysis. Results: MPM patients could be discriminated from HC, AEx, ARD, BLD and LC patients with 65%, 88%, 82%, 80% and 72% accuracy, respectively. Combining AEx and ARD patients resulted in 94% sensitivity and 96% negative predictive value (NPV). The VOCs selected as most important were P1, P3, P7, P9, P21, P26 and P122. Conclusion: We discriminated MPM patients from at risk subjects with great accuracy. The high sensitivity and NPV allows to use breath analysis as exclusive screening tool for MPM.