{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T16:42:38Z","timestamp":1778344958512,"version":"3.51.4"},"reference-count":44,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2024,4,7]],"date-time":"2024-04-07T00:00:00Z","timestamp":1712448000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Screening methods available for colorectal cancer (CRC) to date are burdened by poor reliability and low patient adherence and compliance. An altered pattern of volatile organic compounds (VOCs) in exhaled breath has been proposed as a non-invasive potential diagnostic tool for distinguishing CRC patients from healthy controls (HC). The aim of this study was to evaluate the reliability of an innovative portable device containing a micro-gas chromatograph in enabling rapid, on-site CRC diagnosis through analysis of patients\u2019 exhaled breath. In this prospective trial, breath samples were collected in a tertiary referral center of colorectal surgery, and analysis of the chromatograms was performed by the Biomedical Engineering Department. The breath of patients with CRC and HC was collected into Tedlar bags through a Nafion filter and mouthpiece with a one-way valve. The breath samples were analyzed by an automated portable gas chromatography device. Relevant volatile biomarkers and discriminant chromatographic peaks were identified through machine learning, linear discriminant analysis and principal component analysis. A total of 68 subjects, 36 patients affected by histologically proven CRC with no evidence of metastases and 32 HC with negative colonoscopies, were enrolled. After testing a training set (18 CRC and 18 HC) and a testing set (18 CRC and 14 HC), an overall specificity of 87.5%, sensitivity of 94.4% and accuracy of 91.2% in identifying CRC patients was found based on three VOCs. Breath biopsy may represent a promising non-invasive method of discriminating CRC patients from HC.<\/jats:p>","DOI":"10.3390\/s24072343","type":"journal-article","created":{"date-parts":[[2024,4,8]],"date-time":"2024-04-08T06:04:58Z","timestamp":1712556298000},"page":"2343","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Colorectal Cancer Diagnosis through Breath Test Using a Portable Breath Analyzer\u2014Preliminary Data"],"prefix":"10.3390","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6361-1111","authenticated-orcid":false,"given":"Arcangelo","family":"Picciariello","sequence":"first","affiliation":[{"name":"Department of Experimental Medicine, University of Salento, 73100 Lecce, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Agnese","family":"Dezi","sequence":"additional","affiliation":[{"name":"Department of Precision and Regenerative Medicine and Ionian Area and Interdepartmental Research Center for Pelvic Floor Diseases (CIRPAP), University Aldo Moro of Bari, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leonardo","family":"Vincenti","sequence":"additional","affiliation":[{"name":"Surgical Unit, IRCCS de Bellis, Castellana Grotte, 70013 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4036-6819","authenticated-orcid":false,"given":"Marcello Giuseppe","family":"Spampinato","sequence":"additional","affiliation":[{"name":"Department of Surgery, \u201cVito Fazzi\u201d Hospital, Piazza Filippo Muratore, 73100 Lecce, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenzhe","family":"Zang","sequence":"additional","affiliation":[{"name":"Biomedical Engineering Department, University of Michigan, 1101 Beal Ave., Ann Arbor, MI 48109, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pamela","family":"Riahi","sequence":"additional","affiliation":[{"name":"Biomedical Engineering Department, University of Michigan, 1101 Beal Ave., Ann Arbor, MI 48109, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jared","family":"Scott","sequence":"additional","affiliation":[{"name":"Biomedical Engineering Department, University of Michigan, 1101 Beal Ave., Ann Arbor, MI 48109, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruchi","family":"Sharma","sequence":"additional","affiliation":[{"name":"Biomedical Engineering Department, University of Michigan, 1101 Beal Ave., Ann Arbor, MI 48109, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0149-1326","authenticated-orcid":false,"given":"Xudong","family":"Fan","sequence":"additional","affiliation":[{"name":"Biomedical Engineering Department, University of Michigan, 1101 Beal Ave., Ann Arbor, MI 48109, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8980-2752","authenticated-orcid":false,"given":"Donato F.","family":"Altomare","sequence":"additional","affiliation":[{"name":"Department of Precision and Regenerative Medicine and Ionian Area and Interdepartmental Research Center for Pelvic Floor Diseases (CIRPAP), University Aldo Moro of Bari, 70124 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,4,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1136\/gutjnl-2015-310912","article-title":"Global patterns and trends in colorectal cancer incidence and mortality","volume":"66","author":"Arnold","year":"2017","journal-title":"Gut"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"483","DOI":"10.5694\/mja18.00279","article-title":"Colorectal cancer screening reduces incidence, mortality and morbidity","volume":"208","author":"Jideh","year":"2018","journal-title":"Med. J. Aust."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"n1855","DOI":"10.1136\/bmj.n1855","article-title":"Screening and prevention of colorectal cancer","volume":"374","author":"Kanth","year":"2021","journal-title":"BMJ"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1111\/1751-2980.12712","article-title":"Fecal occult blood test in colorectal cancer screening","volume":"20","author":"Li","year":"2019","journal-title":"J. Dig. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1734","DOI":"10.1056\/NEJMsr1714643","article-title":"The IARC Perspective on Colorectal Cancer Screening","volume":"378","author":"Vilahur","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.tips.2016.10.013","article-title":"Cancer Precision Medicine: From Cancer Screening to Drug Selection and Personalized Immunotherapy","volume":"38","author":"Deng","year":"2017","journal-title":"Trends Pharmacol. Sci."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e230982","DOI":"10.1001\/jamanetworkopen.2023.0982","article-title":"Portable Breath-Based Volatile Organic Compound Monitoring for the Detection of COVID-19 During the Circulation of the SARS-CoV-2 Delta Variant and the Transition to the SARS-CoV-2 Omicron Variant","volume":"6","author":"Sharma","year":"2023","journal-title":"JAMA Netw. Open"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1093\/jalm\/jfac040","article-title":"Role of Breath Biopsy in COVID-19","volume":"7","author":"Shekhawat","year":"2022","journal-title":"J. Appl. Lab. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1016\/j.molmed.2015.08.001","article-title":"Exhaled Molecular Fingerprinting in Diagnosis and Monitoring: Validating Volatile Promises","volume":"21","author":"Boots","year":"2015","journal-title":"Trends Mol. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1111\/apt.15140","article-title":"Volatile organic compounds emitted from faeces as a biomarker for colorectal cancer","volume":"49","author":"Bond","year":"2019","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1259","DOI":"10.1111\/codi.14739","article-title":"Urinary volatile organic compounds and faecal microbiome profiles in colorectal cancer","volume":"21","author":"McFarlane","year":"2019","journal-title":"Color. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1002\/bjs.8942","article-title":"Exhaled volatile organic compounds identify patients with colorectal cancer","volume":"100","author":"Altomare","year":"2013","journal-title":"Br. J. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Wen, Q., Boshier, P., Myridakis, A., Belluomo, I., and Hanna, G.B. (2020). Urinary Volatile Organic Compound Analysis for the Diagnosis of Cancer: A Systematic Literature Review and Quality Assessment. Metabolites, 11.","DOI":"10.3390\/metabo11010017"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/0891-5849(94)90110-4","article-title":"The potential of the hydrocarbon breath test as a measure of lipid peroxidation","volume":"17","author":"Kneepkens","year":"1994","journal-title":"Free Radic. Biol. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2663","DOI":"10.1002\/ijc.24970","article-title":"Breath gas aldehydes as biomarkers of lung cancer","volume":"126","author":"Fuchs","year":"2010","journal-title":"Int. J. Cancer"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"026003","DOI":"10.1088\/1752-7155\/4\/2\/026003","article-title":"Volatile biomarkers in the breath of women with breast cancer","volume":"4","author":"Phillips","year":"2010","journal-title":"J. Breath Res."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Abaffy, T., Duncan, R., Riemer, D.D., Tietje, O., Elgart, G., Milikowski, C., and DeFazio, R.A. (2010). Differential volatile signatures from skin, naevi and melanoma: A novel approach to detect a pathological process. PLoS ONE, 5.","DOI":"10.1371\/journal.pone.0013813"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Tsou, P.H., Lin, Z.L., Pan, Y.C., Yang, H.C., Chang, C.J., Liang, S.K., Wen, Y.F., Chang, C.H., Chang, L.Y., and Yu, K.L. (2021). Exploring Volatile Organic Compounds in Breath for High-Accuracy Prediction of Lung Cancer. Cancers, 13.","DOI":"10.3390\/cancers13061431"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"044002","DOI":"10.1088\/1752-7163\/ac2cde","article-title":"Breath volatile organic compound analysis: An emerging method for gastric cancer detection","volume":"15","author":"Zhang","year":"2021","journal-title":"J. Breath Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1002\/bjs5.50354","article-title":"Chemical signature of colorectal cancer: Case-control study for profiling the breath print","volume":"4","author":"Altomare","year":"2020","journal-title":"BJS Open"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"6435","DOI":"10.1007\/s00216-019-02024-5","article-title":"Rapid breath analysis for acute respiratory distress syndrome diagnostics using a portable two-dimensional gas chromatography device","volume":"411","author":"Zhou","year":"2019","journal-title":"Anal. Bioanal. Chem."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Sharma, R., Zang, W., Zhou, M., Schafer, N., Begley, L.A., Huang, Y.J., and Fan, X. (2021). Real Time Breath Analysis Using Portable Gas Chromatography for Adult Asthma Phenotypes. Metabolites, 11.","DOI":"10.3390\/metabo11050265"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Gillies, C.E., Jennaro, T.S., Puskarich, M.A., Sharma, R., Ward, K.R., Fan, X., Jones, A.E., and Stringer, K.A. (2020). A Multilevel Bayesian Approach to Improve Effect Size Estimation in Regression Modeling of Metabolomics Data Utilizing Imputation with Uncertainty. Metabolites, 10.","DOI":"10.3390\/metabo10080319"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"016013","DOI":"10.1088\/1752-7163\/aa5cc5","article-title":"Factors that influence the volatile organic compound content in human breath","volume":"11","author":"Blanchet","year":"2017","journal-title":"J. Breath Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1186\/s13046-020-01569-z","article-title":"Cross-sectional analysis of circulating tumor DNA in primary colorectal cancer at surgery and during post-surgery follow-up by liquid biopsy","volume":"39","author":"Allegretti","year":"2020","journal-title":"J. Exp. Clin. Cancer Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"124","DOI":"10.4251\/wjgo.v12.i2.124","article-title":"Biomarkers for detecting colorectal cancer non-invasively: DNA, RNA or proteins?","volume":"12","author":"Loktionov","year":"2020","journal-title":"World J. Gastrointest. Oncol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1053\/j.gastro.2023.05.037","article-title":"A Fecal MicroRNA Signature by Small RNA Sequencing Accurately Distinguishes Colorectal Cancers: Results from a Multicenter Study","volume":"165","author":"Pardini","year":"2023","journal-title":"Gastroenterology"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"O100","DOI":"10.1111\/codi.12917","article-title":"The accuracy of circulating microRNA-21 in the diagnosis of colorectal cancer: A systematic review and meta-analysis","volume":"17","author":"Xu","year":"2015","journal-title":"Color. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Chung, J., Akter, S., Han, S., Shin, Y., Choi, T.G., Kang, I., and Kim, S.S. (2022). Diagnosis by Volatile Organic Compounds in Exhaled Breath in Exhaled Breath from Patients with Gastric and Colorectal Cancers. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24010129"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1002\/ijc.29701","article-title":"Breath testing as potential colorectal cancer screening tool","volume":"138","author":"Amal","year":"2016","journal-title":"Int. J. Cancer"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1097\/SLA.0000000000002539","article-title":"Breath Volatile Organic Compound Profiling of Colorectal Cancer Using Selected Ion Flow-tube Mass Spectrometry","volume":"269","author":"Markar","year":"2019","journal-title":"Ann. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"4757","DOI":"10.1007\/s00216-014-7865-x","article-title":"Noninvasive detection of colorectal cancer by analysis of exhaled breath","volume":"406","author":"Wang","year":"2014","journal-title":"Anal. Bioanal. Chem."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1111\/apt.15622","article-title":"Volatile organic compounds in breath can serve as a non-invasive diagnostic biomarker for the detection of advanced adenomas and colorectal cancer","volume":"51","author":"Jansen","year":"2020","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Wilson, A.D. (2018). Application of Electronic-Nose Technologies and VOC-Biomarkers for the Noninvasive Early Diagnosis of Gastrointestinal Diseases (dagger). Sensors, 18.","DOI":"10.3390\/s18082613"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2068","DOI":"10.1016\/j.ejso.2020.07.028","article-title":"Feasibility of volatile organic compound in breath analysis in the follow-up of colorectal cancer: A pilot study","volume":"46","author":"Steenhuis","year":"2020","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"De Vietro, N., Aresta, A., Rotelli, M.T., Zambonin, C., Lippolis, C., Picciariello, A., and Altomare, D.F. (2020). Relationship between cancer tissue derived and exhaled volatile organic compound from colorectal cancer patients. Preliminary results. J. Pharm. Biomed. Anal., 180.","DOI":"10.1016\/j.jpba.2019.113055"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1097\/SLA.0000000000001471","article-title":"Effects of Curative Colorectal Cancer Surgery on Exhaled Volatile Organic Compounds and Potential Implications in Clinical Follow-up","volume":"262","author":"Altomare","year":"2015","journal-title":"Ann. Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1007\/s00384-021-04055-w","article-title":"Adherence to fecal immunochemical test screening among adults at average risk for colorectal cancer","volume":"37","author":"Fisher","year":"2022","journal-title":"Int. J. Color. Dis."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Elefante, A., Menduni, G., Rossmadl, H., Mackowiak, V., Giglio, M., Sampaolo, A., Patimisco, P., Passaro, V.M.N., and Spagnolo, V. (2020). Environmental Monitoring of Methane with Quartz-Enhanced Photoacoustic Spectroscopy Exploiting an Electronic Hygrometer to Compensate the H2O Influence on the Sensor Signal. Sensors, 20.","DOI":"10.3390\/s20102935"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"011106","DOI":"10.1063\/1.5013612","article-title":"Recent advances in quartz enhanced photoacoustic sensing","volume":"5","author":"Patimisco","year":"2018","journal-title":"Appl. Phys. Rev."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"6165","DOI":"10.3390\/s140406165","article-title":"Quartz-enhanced photoacoustic spectroscopy: A review","volume":"14","author":"Patimisco","year":"2014","journal-title":"Sensors"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"6399","DOI":"10.3748\/wjg.v27.i38.6399","article-title":"Artificial intelligence for the early detection of colorectal cancer: A comprehensive review of its advantages and misconceptions","volume":"27","author":"Viscaino","year":"2021","journal-title":"World J. Gastroenterol."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Gallos, I.K., Tryfonopoulos, D., Shani, G., Amditis, A., Haick, H., and Dionysiou, D.D. (2023). Advancing Colorectal Cancer Diagnosis with AI-Powered Breathomics: Navigating Challenges and Future Directions. Diagnostics, 13.","DOI":"10.3390\/diagnostics13243673"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1581","DOI":"10.3390\/curroncol28030149","article-title":"Artificial Intelligence in Colorectal Cancer Screening, Diagnosis and Treatment. A New Era","volume":"28","author":"Mitsala","year":"2021","journal-title":"Curr. Oncol."}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/24\/7\/2343\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:24:21Z","timestamp":1760106261000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/24\/7\/2343"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,7]]},"references-count":44,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2024,4]]}},"alternative-id":["s24072343"],"URL":"https:\/\/doi.org\/10.3390\/s24072343","relation":{},"ISSN":["1424-8220"],"issn-type":[{"value":"1424-8220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,7]]}}}