Development of a non-invasive exhaled breath test for the diagnosis of head and neck cancer

Br J Cancer. 2020 Dec;123(12):1775-1781. doi: 10.1038/s41416-020-01051-9. Epub 2020 Sep 9.


Background: Improving the ability to identify early-stage head and neck squamous cell carcinoma (HNSCC) can improve treatment outcomes and patient morbidity. We sought to determine the diagnostic accuracy of breath analysis as a non-invasive test for detecting HNSCC.

Methods: Standardised breath samples were collected from 181 patients suspected of HNSCC prior to any treatment. A selected ion flow-tube mass spectrometer was used to analyse breath for volatile organic compounds. Diagnosis was confirmed by histopathology. A binomial logistic regression model was used to differentiate breath profiles between cancer and control (benign disease) patients based on mass spectrometry derived variables.

Results: In all, 66% of participants had early-stage primary tumours (T1 and T2) and 58% had regional node metastasis. The optimised logistic regression model using three variables had a sensitivity and specificity of 80% and 86%, respectively, with an AUC for ROC curve of 0.821 (95%CI 0.625-1.0) in the testing cohort.

Conclusions: Breath analysis for non-invasive diagnosis of HNSCC appears to be practical and accurate. Future studies should be conducted in a primary care setting to determine the applicability of breath analysis for early identification of HNSCC.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Area Under Curve
  • Breath Tests / methods*
  • Early Detection of Cancer / methods*
  • Exhalation
  • Female
  • Head and Neck Neoplasms / diagnosis*
  • Head and Neck Neoplasms / pathology
  • Humans
  • Logistic Models
  • Lymphatic Metastasis
  • Male
  • Mass Spectrometry
  • Middle Aged
  • Neoplasm Staging / methods
  • ROC Curve
  • Sensitivity and Specificity
  • Sex Factors
  • Squamous Cell Carcinoma of Head and Neck / diagnosis*
  • Squamous Cell Carcinoma of Head and Neck / pathology
  • Squamous Cell Carcinoma of Head and Neck / secondary
  • Volatile Organic Compounds / analysis*


  • Volatile Organic Compounds