Emphysema: Symptoms, stages, causes, treatments, and outlook

Novel Device Uses A Simple Blood Test To Detect Early Stage Lung Cancer

University of Queensland researchers have designed a device that uses a simple blood test to detect early stage lung cancer.

Quan Zhou holds up the device his laboratory is using to explore faster, more accurate methods of diagnosis. Image: The University of Queensland.

Dr Richard Lobb and Quan Zhou from UQ's Australian Institute for Bioengineering and Nanotechnology said the diagnostic device could help patients begin treatment and get ahead of the disease before it spreads.

"Lung cancer is the most common cause of cancer death in Australia, claiming the lives of almost 9000 people each year," Dr Lobb said.

"Despite its prevalence, the initial detection and screening process for the disease can be drawn out and expensive, involving scans, imaging tests and biopsy procedures.

"The technology we've developed is non-invasive and can detect very small lung cancer nodules to hopefully catch the disease in the first stage."

The nanodevice analyses the patient's blood sample, looking for a particular biomarker – the sugars that coat the tiny messenger particles known as extracellular vesicles (EVs).

"These sugar molecules, or glycans, serve as excellent biomarkers because the sugar code on a cancer cell is different to a normal cell," Dr Lobb said.

"A drop of blood can be all that's needed to alert clinicians to the presence of small lung cancer nodules and allow intervention while the disease is in its early stages," Dr Lobb said.

A clinical study involving 40 patients found the technology successfully differentiated patients with early-stage malignant lung nodules from those with benign lung nodules. 

The results show the potential to use EV glycans to diagnose other diseases non-invasively. This device, and a simple blood test, could help clinicians step in before more intensive scanning or treatments or drug regimes are needed." 

Quan Zhou, UQ's Australian Institute for Bioengineering and Nanotechnology

The nanodevice was designed in the lab of ARC Laureate and AIBN senior group leader Professor Matt Trau, with AIBN scholars Xueming Niu, Dr Alain Wuethrich and Dr Zhen Zhang contributing to the research.

The research paper was published in Advanced Science.

Source:

Journal reference:

Zhou, Q., et al. (2024). Glycan Profiling in Small Extracellular Vesicles with a SERS Microfluidic Biosensor Identifies Early Malignant Development in Lung Cancer. Advanced Science. Doi.Org/10.1002/advs.202401818.

A Promising New Test For Lung Cancer: The Noninvasive E-Nose

Detecting lung cancer as early as possible has long been a goal of the specialists at MSK, because it gives doctors the most treatment options, which can improve outcomes for patients.   

A team led by MSK thoracic surgeon Gaetano Rocco, MD, reported results in a clinical trial that tested a screening method known as "E-nose."

The trial suggests that E-nose could one day become an important tool in detecting lung cancer because the approach is noninvasive, highly accurate, inexpensive — and may one day even be small enough to slip inside a clinician's pocket.

"E-nose looks really worthwhile," Dr. Rocco says. "We anticipate this method could revolutionize the diagnosis of early-stage lung cancer, making screening accessible to more people." 

How the E-Nose Detects Lung Cancer                         

The E-nose uses technology that can "smell" lung cancer in a person's breath. "Chemicals called volatile organic compounds (VOCs) are emitted by cancer cells," Dr. Rocco explains. "And they can be detected even at early stages of the disease."

The E-nose was given that name because "it mimics what our own noses do," he says, "by sensing the various combinations of VOCs and recognizing those that signal cancer."

The E-nose involves two procedures. First, a person breathes into a collection device for three minutes. A sensor the size of a USB drive converts VOCs in the person's breath into electronic signals called a "breathprint." The breathprint is then analyzed by a separate machine that can detect the presence of cancer in just a few hours.

Right now, the analysis machine is at an academic medical center in Italy, which means that the collected breathprint samples get shipped overseas. But Dr. Rocco is hopeful that the machine will be replicated and miniaturized so that the technology could be easily used in a doctor's office to quickly test for lung cancer at very low cost. 

E-Nose Clinical Trial Results

Dr. Rocco's experience with the E-nose began nearly 10 years ago in his native Italy, where the E-nose was shown to perform very well in two key aspects of a screening test, known as sensitivity (86%) and specificity (95%). He explains that "sensitivity means you can believe the test if it says you have a disease, and specificity means you can believe the test if it says you do not have a disease."

Those findings prompted Dr. Rocco to lead a phase 2 clinical trial at MSK to investigate the E-nose, which is formally known as BIONOTE (BIOsensor-based multisensorial system for mimicking NOse, Tongue, and Eyes). The results were published in the Journal of Thoracic Oncology in May 2024.

The trial involved 100 participants from 21 to 85 years of age who were referred to MSK with a lung nodule and presumed to be at high risk for having lung cancer. A lung nodule is a small, dense mass of tissue in the lungs that can be cancerous or noncancerous. 

In the trial, breathprints were created for each participant, and the E-nose found:

Cancer in 86 of the 88 patients who were confirmed to have lung cancer

86 true positives

2 false negatives

12 false positives

Dr. Rocco says, "The E-nose reliably detected early-stage lung cancer and was very accurate when compared with the long-established available imaging methods" such as X-rays and CT and PET scans.

The final diagnosis of lung cancer relies on a biopsy of the lung nodule, which often uses needles to remove a small amount of tissue to study. In the MSK clinical trial, the E-nose agreed with the results of biopsy in 86% of the patients. He adds "our results suggest the E-nose would be an excellent addition to the current techniques for diagnosing lung cancer—and would pose no risk to the patient because it's noninvasive."

Learn more about lung cancer screening guidelines

Learn more about how we screen for lung cancer at MSK

The People Who Would Most Benefit from E-Nose

Dr. Rocco believes that adding a noninvasive, inexpensive screening option like E-nose may encourage more people who should get screened to do so. Research finds that only 1 in 5 people who are eligible for lung cancer screening actually get it.

Declines in smoking and advances in treating lung cancer have helped lower the incidence and death rate from lung cancer. But the grim truth about lung cancer, according to the American Cancer Society, is that it is the second most common cancer in both men and women in the U.S.

Even worse, lung cancer is by far the leading cause of cancer death in the U.S. — more than colon, breast, and prostate cancers combined.

Dr. Rocco believes one of the first use cases for the E-nose would be for people "who really don't want to undergo a biopsy or can't because of severe respiratory disease. That is one of the main aims of the E-nose." 

He says the E-nose could also be useful for large-scale lung cancer screening, particularly in remote areas where imaging and biopsy options are limited.

Dr. Rocco is hopeful that philanthropic support will help further refine the E-nose technology, and that continuing clinical trials will lead to widespread adoption.

"E-nose could be a valuable addition to diagnosing and treating lung cancer," he says, "and MSK's expertise and leadership in the field means it's the right place to make this a reality."

The Journal of Thoracic Oncology paper was supported in part by a National Institutes of Health/National Cancer Institute Cancer Center Support Grant P30 CA008748 and MSK's Fiona and Stanley Druckenmiller Research Center for Lung Cancer Research. Dr. Rocco reported a financial interest with Scanlan International, Merck, and Medtronic. Refer to the paper for disclosures from other authors.

Lesion On Lung Could Be Scar Tissue, Infection, Cancer, Etc.

Posted July 10

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Dr. Keith Roach

DEAR DR. ROACH: My childhood friend just emailed me that she has a 1.1-cm lesion on her lung. It was found on a CT scan. She's having another CT scan today. She is a former smoker and has COPD. Is the lesion something that's part of COPD? What's the difference between a lesion and something else? — J.B.ANSWER: A "lesion" is simply a term that means something doesn't belong there, but in this case, the suspicion is that it means some kind of mass. The big concern in a current or former smoker is lung cancer. The appearance of the lesion in the CT scan can help tell what it represents.There are calculators that can help give an idea of how likely a lung lesion (we often use the term "nodule" for a solid lesion) is to be cancer. Based only on the information you gave me, there's about a 15%-20% chance of cancer, which is high enough that she would be recommended a biopsy. Depending on where it is in the lung, the biopsy can be done by bronchoscopy, ultrasound, or a CT-guided biopsy through the skin if the nodule isn't close enough to a large airway.If it (hopefully) isn't cancer, it could be scar tissue, a current or past infection, a benign tumor, or many other possibilities, almost all of which are better than lung cancer.DEAR DR. ROACH: My husband has Type 2 diabetes and has been on Trulicity for a few years with great results. Lately, when it's time for refills, the pharmacies are saying that it's on back order and not available for three to four weeks. I am concerned how this affects his diabetes and health. Why is there this discrepancy? — K.F.ANSWER: Dulaglutide (Trulicity) is in the class of GLP-1 agonists, like semaglutide (Ozempic and Wegovy). Not only are they good treatments for diabetes, they tend to promote weight loss and reduce the risk of heart disease. Consequently, they are in high demand.Semaglutide and a similar drug, tirzepatide, have been approved for weight loss by the Food and Drug Administration, while Trulicity has not. However, many insurance companies are demanding that their customers try a different drug when their doctor has prescribed semaglutide, and dulaglutide is one of the most common ones to try. They are very similar, although Trulicity isn't tested as thoroughly for weight loss. The manufacturer, Eli Lilly, has stated that manufacturing shortages are likely to extend through December 2024.It is very frustrating to have a medicine that you have been taking for years become unavailable, and the potential for harm is significant. It takes the body weeks (or months) to get used to the higher doses, and if a person is off of it for more than a few weeks, they may have to restart at the lowest dose and build up again to the higher dose to avoid severe side effects. For your husband, going without his needed medication will make his diabetes less well-controlled.I'm afraid that I don't have a good solution. The drug companies are making truly enormous profits from these medicines and have every incentive to increase manufacturing (which they are). But demand continues to outstrip supply.* * *Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.Cornell.Edu or send mail to 628 Virginia Dr., Orlando, FL 32803.(c) 2024 North America Syndicate Inc.All Rights Reserved

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