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Meta-Analysis
. 2022 Jun 1;5(6):e2219372.
doi: 10.1001/jamanetworkopen.2022.19372.

Diagnostic Performance of Electronic Noses in Cancer Diagnoses Using Exhaled Breath: A Systematic Review and Meta-analysis

Max H M C Scheepers  1 , Zaid Al-Difaie  1 , Lloyd Brandts  2 , Andrea Peeters  2 , Bart van Grinsven  3 , Nicole D Bouvy  4
Affiliations
Meta-Analysis

Diagnostic Performance of Electronic Noses in Cancer Diagnoses Using Exhaled Breath: A Systematic Review and Meta-analysis

Max H M C Scheepers et al. JAMA Netw Open. .

Abstract

Importance: There has been a growing interest in the use of electronic noses (e-noses) in detecting volatile organic compounds in exhaled breath for the diagnosis of cancer. However, no systematic evaluation has been performed of the overall diagnostic accuracy and methodologic challenges of using e-noses for cancer detection in exhaled breath.

Objective: To provide an overview of the diagnostic accuracy and methodologic challenges of using e-noses for the detection of cancer.

Data sources: An electronic search was performed in the PubMed and Embase databases (January 1, 2000, to July 1, 2021).

Study selection: Inclusion criteria were the following: (1) use of e-nose technology, (2) detection of cancer, and (3) analysis of exhaled breath. Exclusion criteria were (1) studies published before 2000; (2) studies not performed in humans; (3) studies not performed in adults; (4) studies that only analyzed biofluids; and (5) studies that exclusively used gas chromatography-mass spectrometry to analyze exhaled breath samples.

Data extraction and synthesis: PRISMA guidelines were used for the identification, screening, eligibility, and selection process. Quality assessment was performed using Quality Assessment of Diagnostic Accuracy Studies 2. Generalized mixed-effects bivariate meta-analysis was performed.

Main outcomes and measures: Main outcomes were sensitivity, specificity, and mean area under the receiver operating characteristic curve.

Results: This review identified 52 articles with a total of 3677 patients with cancer. All studies were feasibility studies. The sensitivity of e-noses ranged from 48.3% to 95.8% and the specificity from 10.0% to 100.0%. Pooled analysis resulted in a mean (SE) area under the receiver operating characteristic curve of 94% (95% CI, 92%-96%), a sensitivity of 90% (95% CI, 88%-92%), and a specificity of 87% (95% CI, 81%-92%). Considerable heterogeneity existed among the studies because of differences in the selection of patients, endogenous and exogenous factors, and collection of exhaled breath.

Conclusions and relevance: Results of this review indicate that e-noses have a high diagnostic accuracy for the detection of cancer in exhaled breath. However, most studies were feasibility studies with small sample sizes, a lack of standardization, and a high risk of bias. The lack of standardization and reproducibility of e-nose research should be addressed in future research.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.
Figure 1.. Identification, Screening, Eligibility, and Selection Process
e-Nose indicates electronic nose; GC-MS, gas chromatography–mass spectrometry.
Figure 2.
Figure 2.. Summary Receiver Operating Characteristic (SROC) Curve Analysis of All Electronic Noses
For the summary operating point, sensitivity was 0.90 (95% CI, 0.88-0.92) and specificity was 0.87 (95% CI, 0.81-0.92). For the SROC curve, the area under the curve was 0.94 (95% CI, 0.92-0.95).
Figure 3.
Figure 3.. Pooled Sensitivity and Specificity Analyses of All Electronic Noses
See this image and copyright information in PMC

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