title: Breath biomarkers for lung cancer detection and assessment of smoking related effects--confounding variables, influence of normalization and statistical algorithms.
abstract: BACKGROUND
  Up to now, none of the breath biomarkers or marker sets proposed for cancer recognition has reached clinical relevance. Possible reasons are the lack of standardized methods of sampling, analysis and data processing and effects of environmental contaminants.
  
  
  METHODS
  Concentration profiles of endogenous and exogenous breath markers were determined in exhaled breath of 31 lung cancer patients, 31 smokers and 31 healthy controls by means of SPME-GC-MS. Different correcting and normalization algorithms and a principal component analysis were applied to the data.
  
  
  RESULTS
  Differences of exhalation profiles in cancer and non-cancer patients did not persist if physiology and confounding variables were taken into account. Smoking history, inspired substance concentrations, age and gender were recognized as the most important confounding variables. Normalization onto PCO2 or BSA or correction for inspired concentrations only partially solved the problem. In contrast, previous smoking behaviour could be recognized unequivocally.
  
  
  CONCLUSIONS
  Exhaled substance concentrations may depend on a variety of parameters other than the disease under investigation. Normalization and correcting parameters have to be chosen with care as compensating effects may be different from one substance to the other. Only well-founded biomarker identification, normalization and data processing will provide clinically relevant information from breath analysis.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Rostock, Schillingallee 35, D-18057 Rostock, Germany. sabine.kischkel@uni-rostock.de
authors.forename: Sabine
authors.initials: S
authors.lastname: Kischkel
authors.forename: Wolfram
authors.initials: W
authors.lastname: Miekisch
authors.forename: Annika
authors.initials: A
authors.lastname: Sawacki
authors.forename: Eva M
authors.initials: EM
authors.lastname: Straker
authors.forename: Phillip
authors.initials: P
authors.lastname: Trefz
authors.forename: Anton
authors.initials: A
authors.lastname: Amann
authors.forename: Jochen K
authors.initials: JK
authors.lastname: Schubert
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D015415:Biomarkers / Q000032:analysis; D001944:Breath Tests / Q000379:methods*; D016022:Case-Control Studies; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis*; D008297:Male; D012016:Reference Values; D012107:Research Design / Q000592:standards; D012907:Smoking / Q000009:adverse effects*
chemical_list: D015415:Biomarkers