Correlating volatile diagnostic biomarkers in exhaled breath to computed tomography imaging in an asbestos-exposed population

<bold>Background:</bold> Inhalation of asbestos, a known carcinogen, elevates the risk of developing lung cancer (LC) and pleural mesothelioma (PM). As there is no cure for PM, surveillance of asbestos-exposed (AEx) populations is not advised. However, early discovery may aid patients. For LC, screening options, like the NELSON trial (de Koning <italic>N Engl J Med</italic> 2020), exist. <bold>Aim:</bold> To assess whether a breath print, based upon volatile organic compounds (VOCs) correlates with Computed Tomography (CT) imaging as predictor of malignancy in an AEx population. <bold>Methods:</bold> Exhaled VOCs were analysed in 121 AEx individuals by ion mobility spectrometry for 2 consecutive years (Zwijsen <italic>JBR</italic> 2023) and the risk of malignancy was predicted based on VOC patterns. We performed CT imaging in those who had two positive predictions of malignancy by breath tests. <bold>Results:</bold> Out of 54 patients with double positive breath tests, 49 (40.5%) underwent a follow-up CT scan, revealing pleural plaques in 53% of them (See figure). However, no PM diagnosis was established. Surprisingly, 6 lung nodules suspected of cancer were found, with only 2 meeting the NELSON trial's lung cancer screening criteria. <fig><object-id>erj;64/suppl_68/OA3795/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig> <bold>Conclusion:</bold> VOCs may be used as a follow-up method for AEx populations in addition to CT imaging. Other thoracic malignancies, including LC, may be more likely to be detected when VOCs and CT scans are used together, even if they are not PM-specific.