title: Electronic nose technology for detection of invasive pulmonary aspergillosis in prolonged chemotherapy-induced neutropenia: a proof-of-principle study.
abstract: Although the high mortality rate of pulmonary invasive aspergillosis (IA) in patients with prolonged chemotherapy-induced neutropenia (PCIN) can be reduced by timely diagnosis, a diagnostic test that reliably detects IA at an early stage is lacking. We hypothesized that an electronic nose (eNose) could fulfill this need. An eNose can discriminate various lung diseases through the analysis of exhaled volatile organic compounds (VOCs). An eNose is cheap and noninvasive and yields results within minutes. In a single-center prospective cohort study, we included patients who were treated with chemotherapy expected to result in PCIN. Based on standardized indications, a full diagnostic workup was performed to confirm invasive aspergillosis or to rule it out. Patients with no aspergillosis were considered controls, and patients with probable or proven aspergillosis were considered index cases. Exhaled breath was examined with a Cyranose 320 (Smith Detections, Pasadena, CA). The resulting data were analyzed using principal component reduction. The primary endpoint was cross-validated diagnostic accuracy, defined as the percentage of patients correctly classified using the leave-one-out method. Accuracy was validated by 100,000 random classifications. We included 46 subjects who underwent 16 diagnostic workups, resulting in 6 cases and 5 controls. The cross-validated accuracy of the eNose in diagnosing IA was 90.9% (P = 0.022; sensitivity, 100%; specificity, 83.3%). Receiver operating characteristic analysis showed an area under the curve of 0.93. These preliminary data indicate that PCIN patients with IA have a distinct exhaled VOC profile that can be detected with eNose technology. The diagnostic accuracy of the eNose for invasive aspergillosis warrants validation.
authors: Department of Hematology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. koen@de-heer.eu
authors: Koen
authors: K
authors: de Heer
authors: Marc P
authors: MP
authors: van der Schee
authors: Koos
authors: K
authors: Zwinderman
authors: Inge A H
authors: IA
authors: van den Berk
authors: Caroline Elisabeth
authors: CE
authors: Visser
authors: Rien
authors: R
authors: van Oers
authors: Peter J
authors: PJ
authors: Sterk
mesh_terms: D000328:Adult; D000368:Aged; D001944:Breath Tests / Q000379:methods*; D015331:Cohort Studies; D062609:Electronic Nose; D045853:Exhalation; D005260:Female; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced* / Q000150:complications; D025341:Principal Component Analysis; D011446:Prospective Studies; D012372:ROC Curve; D055549:Volatile Organic Compounds / Q000032:analysis*
chemical_list: D055549:Volatile Organic Compounds