Smartphone-Based Platforms for Clinical Detections in Lung-Cancer-Related Exhaled Breath Biomarkers: A Review.

Lung cancer has been studied for decades because of its high morbidity and high mortality. Traditional methods involving bronchoscopy and needle biopsy are invasive and expensive, which makes patients suffer more risks and costs. Various noninvasive lung cancer markers, such as medical imaging indices, volatile organic compounds (VOCs), and exhaled breath condensates (EBCs), have been discovered for application in screening, diagnosis, and prognosis. However, the detection of markers still relies on bulky and professional instruments, which are limited to training personnel or laboratories. This seriously hinders population screening for early diagnosis of lung cancer. Advanced smartphones integrated with powerful applications can provide easy operation and real-time monitoring for healthcare, which demonstrates tremendous application scenarios in the biomedical analysis region from medical institutions or laboratories to personalized medicine. In this review, we propose an overview of lung-cancer-related noninvasive markers from exhaled breath, focusing on the novel development of smartphone-based platforms for the detection of these biomarkers. Lastly, we discuss the current limitations and potential solutions.

Calculated indices of volatile organic compounds (VOCs) in exhalation for lung cancer screening and early detection.

BACKGROUND: Breath analysis is a promising noninvasive technique that offers a wide range of opportunities to facilitate early diagnosis of lung cancer (LC). METHOD: Exhaled breath samples of 352 subjects including 160 with lung cancer (LC), 70 with benign pulmonary nodule (BPN) and 122 healthy controls (HC) were analyzed through thermal desorption coupled with gas chromatography-mass spectrometry (TD-GC-MS) to obtain the metabolic information from volatile organic compounds (VOCs). Statistical classification models were used to find diagnostic clusters of VOCs for the discrimination of HC, BPN and LC patients' early and advanced stages, as well as subtypes of LC. Receiver operator characteristics (ROC) curves with 5-fold validations were used to evaluate the accuracy of these models. RESULTS: The analysis revealed that 20, 19, 19, and 20 VOCs discriminated LC from HC, LC from BPN, histology and LC stages respectively. The calculated diagnostic indices showed a large area under the curve (AUC) to distinguish HC from LC (AUC: 0.987, 95 % confidence interval (CI): 0.976-0.997), BPN from LC (AUC: 0.809, 95 % CI: 0.758-0.860), NSCLC from SCLC (AUC: 0.939, 95 % CI: 0.875-0.995) and Stage III from stage III-IV (AUC: 0.827, 95 % CI: 0.768-0.886). The comparison between the high-risk groups (BPN and HC smokers) and early stages LC resulted in the AUC of 0.756 (95 %CI: 0.681-0.817) for BPN vs. early stage LC and AUC of 0.986 (95 % CI: 0.972-0.994) for HC smoker vs. early stage LC. CONCLUSION: Volatome of breath of the LC patients was significantly different from that of both BPN patients and HC and showed an ability of distinguishing early from advance stage LC and NSCLC from SCLC. We conclude that the volatome has a potential to help improve early diagnosis of LC.

Effect of X-ray irradiation on hepatocarcinoma cells and erythrocytes in salvaged blood.

The broad clinical acceptance of intraoperative blood salvage and its applications in cancer surgery remain controversial. Until now, a method that can safely eliminate cancer cells while preserving erythrocytes does not exist. Here, we investigated whether X-ray generated from linear accelerator irradiation at a certain dose can kill hepatocarcinoma cells while preserving erythrocytes. HepG2, SK-Hep1 or Huh7 cells were mixed into the aliquots of erythrocytes obtained from healthy volunteers. After the mixed cells were exposed to 30 Gy and 50 Gy X-rays irradiation, the viability, clonogenicity, DNA synthesis and tumorigenicity of the tumor cells were determined by the MTT assay, plate colony formation, 5-ethynyl-2'-deoxyuridine incorporation, and subcutaneous xenograft implantation into immunocompromised mice. The ATP, 2,3-DPG, free Hb, osmotic fragility, blood gas variables in erythrocytes and morphology of erythrocytes at 0 h, 12 h, 24 h, 48 h, 72 h after irradiation were analyzed. X-ray irradiation at 30 Gy effectively inhibited the viability, proliferation, and tumorigenicity of HepG2, SK-Hep1 and Huh7 cells without noticeably damaging the ability of oxygen-carrying, membrane integrity and morphology of erythrocytes. Theses results suggest that X-ray at 30 Gy irradiation might be safe to eliminate hepatocarcinoma cells while preserving erythrocytes in salvaged blood.