A review of exhaled breath: a key role in lung cancer diagnosis.
呼出氣體：在肺癌診斷中的關(guān)鍵作用
Marzorati D1, Mainardi L, Sedda G, Gasparri R, Spaggiari L, Cerveri P.
1Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy. Department of Thoracic Surgery-IEO, European Institute of Oncology IRCCS, Milan, Italy.
Abstract
One of the main causes of the high mortality rate in lung cancer is the late-stage tumor detection. Early diagnosis is therefore essential to increase the chances of obtaining an effective treatment quickly thus increasing the survival rate. Current screening techniques are based on imaging, with low-dose computed tomography (LDCT) as the pivotal approach. Even if LDCT has high accuracy, its invasiveness and high false positive rate limit its application to high-risk population screening. A non-invasive, cost-efficient, and easy-to-use test should instead be designed as an alternative. Exhaled breath contains thousands of volatile organic compounds (VOCs). Since ancient times, it has been understood that changes in the VOCs' mixture may be directly related to the presence of a disease, and recent studies have quantified the change in the compounds' concentration. Analyzing exhaled breath to achieve lung cancer early diagnosis represents a non-invasive, low-cost, and user-friendly approach, thus being a promising candidate for high-risk lung cancer population screening. This review discusses technological solutions that have been proposed in the literature as tools to analyze exhaled breath for lung cancer diagnosis, together with factors that potentially affect the outcome of the analysis. Even if research on this topic started many years ago, and many different technological approaches have since been adopted, there is still no validated clinical application of this technique. Standard guidelines and protocols should be defined by the medical community in order to translate exhaled breath analysis to clinical practice.
肺癌死亡率高的主要原因之一是晚期腫瘤的發(fā)現(xiàn)。因此，早期診斷對于增加迅速獲得有效治療的機(jī)會從而提高生存率至關(guān)重要。目前的篩查技術(shù)是以影像學(xué)為基礎(chǔ)，以低劑量計算機(jī)斷層掃描(LDCT)為關(guān)鍵手段。即使LDCT具有較高的準(zhǔn)確性，但其侵襲性和高假陽性率限制了其在高危人群篩查中的應(yīng)用。一個非侵入性的，經(jīng)濟(jì)有效的，易于使用的測試應(yīng)該被設(shè)計成一個替代品。呼出的空氣中含有數(shù)千種揮發(fā)性有機(jī)化合物。自古以來，人們就知道VOCs混合物的變化可能與疾病的存在直接相關(guān)，近的研究已經(jīng)量化了化合物濃度的變化。通過分析呼出氣來實現(xiàn)肺癌的早期診斷，是一種無創(chuàng)、低成本、用戶友好的方法，是高危肺癌人群篩查的一個有前途的候選方法。本綜述討論了文獻(xiàn)中提出的技術(shù)解決方案，作為肺癌診斷的呼氣分析工具，以及可能影響分析結(jié)果的因素。即使這方面的研究早在很多年前就開始了，并且已經(jīng)采用了許多不同的技術(shù)方法，但這項技術(shù)仍然沒有得到有效的臨床應(yīng)用。為了將呼氣分析轉(zhuǎn)化為臨床實踐，醫(yī)學(xué)界應(yīng)制定標(biāo)準(zhǔn)指南和規(guī)程。
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