He Yuhang, Su Zhixia, Sha Taining, Yu Xiaoping, Guo Hong, Tao Yujian, Liao Liting, Zhang Yanyan, Lu Guotao, Lu Guangyu, Gong Weijuan
Department of Health Management Center, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China.
School of Nursing, Medical College of Yangzhou University, Yangzhou University, Yangzhou, China.
J Thorac Dis. 2024 Nov 30;16(11):7978-7998. doi: 10.21037/jtd-24-1001. Epub 2024 Nov 29.
The identification of volatile organic compounds (VOCs) in exhaled breath has garnered significant research attention as a means of screening and diagnosing lung cancer in recent decades. However, there is no universally accepted protocol for the collection of breath samples to measure VOCs in the clinical context. The purpose of this study was to summarize the current sampling techniques used to obtain VOCs from exhaled breath specifically in the context of lung cancer screening and diagnosis.
We searched four major literature databases (PubMed, Embase, Web of Science, and The Cochrane Library) to identify studies published from January 1985 to October 2023. Trials that analyzed endogenous VOCs within exhaled breath to screen or diagnose lung cancer were included. The methods used for exhaled breath collection were divided under the following headings: before collection (patient preparation, environmental preparation, contamination detection), during collection (time of breath collection, type of container, breath fraction selected, the volume and route of breath), and after collection (storage of breath samples, VOCs stability).
A total of 89 studies involving 6,409 individuals diagnosed with lung cancer were selected. The methods used to collect the breath varied substantially among the studies. A separate room was prepared for breath collection in 29 studies, the physiological state of the participants was described in 57 studies, and environmental considerations were reported in 41 studies. Polymer bags, specifically Tedlar bags, were the predominant choice for breath sample collection and were used in 58 out of the 89 studies. Alveolar breath was the most commonly selected breath fraction, which was used in 43 studies. Only 15 studies reported the storage conditions of the breath samples, which ranged from -40 ℃ to room temperature, and the stability of VOCs was recorded in 41 studies.
There is an urgent need for breath collection methods to be standardized to maximize the potential of this diagnostic approach. The summarized exhaled breath collection process proposed in this study based on included studies may serve as a method for future clinical research.
近几十年来，呼出气中挥发性有机化合物（VOCs）的识别作为一种筛查和诊断肺癌的手段，已引起了大量研究关注。然而，在临床环境中，尚无普遍接受的用于采集呼出气样本以测量VOCs的方案。本研究的目的是总结目前特别是在肺癌筛查和诊断背景下用于从呼出气中获取VOCs的采样技术。
我们检索了四个主要文献数据库（PubMed、Embase、Web of Science和Cochrane图书馆），以识别1985年1月至2023年10月发表的研究。纳入分析呼出气中内源性VOCs以筛查或诊断肺癌的试验。用于呼出气采集的方法分为以下几类：采集前（患者准备、环境准备、污染检测）、采集期间（呼气采集时间、容器类型、选择的呼出气部分、呼气量和路径）以及采集后（呼出气样本的储存、VOCs稳定性）。
共选择了89项涉及6409名被诊断为肺癌个体的研究。各研究中用于采集呼出气的方法差异很大。29项研究为呼出气采集准备了单独的房间，57项研究描述了参与者的生理状态，41项研究报告了环境因素。聚合物袋，特别是特德拉袋，是呼出气样本采集的主要选择，89项研究中有58项使用了这种袋子。肺泡气是最常选择的呼出气部分，43项研究中使用了该部分。只有15项研究报告了呼出气样本的储存条件，范围从-40℃到室温，41项研究记录了VOCs的稳定性。
迫切需要规范呼出气采集方法，以最大限度发挥这种诊断方法的潜力。本研究基于纳入研究提出的总结性呼出气采集流程可作为未来临床研究的一种方法。
