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3 4 | L O U I S V I L L E . E D U I magine exhaling one breath into a bag to detect the presence of lung cancer. It may one day become a reality, thanks to Xiao-An Fu, PhD, assistant professor of chemical engineering, his team of researchers, and cardiovascular and thoracic surgeon Michael Bousamra, MD. The innovation began when Fu sought to increase the concentration of volatile organic compounds (VOCs) in a breath sample — making them visible under a microscope — in order to study patients with suspicious lung lesions. To solve the problem, he and his team of researchers developed a silicon-coated microchip that binds with ketones in the breath — attached to a medical-grade plastic bag and microtube — that can collect and distill a 1-liter sample of breath to 10,000 times its original concentration. After developing this technology, Fu and his team approached Bousamra to test it in a clinical setting, who in turn began recruiting patients visiting the James Graham Brown Cancer Center to collect the necessary data. By collecting a patient's breath sample and forcing the airflow from the bag through the chip, Fu and Bousamra were able to produce a greater concentration of VOCs and identify four compounds (known as carbonyls) that, when elevated, are indicative of lung cancer. "We don't know why these compounds are elevated in lung cancer patients," said Bousamra. "But we do know that 95 percent of the time, people have cancer when they have three or four of the compounds present." Similarly, the test proved 80 percent predictive of a benign mass in patients. Less invasive than biopsy, the breath test has been shown to quickly determine and expedite treatment following an X-ray or CAT scan that reveals a spot on the lungs. If the compounds do not show up as elevated, a new X-ray or scan could be repeated in six months. While testing is still in its primary stages, Bousamra continues to administer the breath analysis to patients every week at the James Graham Brown Cancer Center. In the immediate future, Fu sees the test helping surgeons and clinicians to differentiate lung cancer from benign nodules. This can lead to many positive benefits to the patient, including early diagnosis, quicker, more targeted treatment and the prevention of biopsy in those who do not present with elevated compounds. Long term, Fu hopes to develop the innovation into a screening device for use by smokers, especially in Kentucky, which has a very high population of smokers. Potentially, Fu asserts, the test will become part of an annual checkup, most notably for patients with a family history of lung cancer and those who are smokers; Bousamra envisions the technology moving into a real-life clinical setting within the next five years. Xiao-An Fu, PhD, Assistant Professor of Chemical Engi- neering and cardiovascular and thoracic surgeon Michael Bousamra, MD, with the device they used to research and diagnose lung cancer. EARLY DETECTION Fu and Bousamra were able to identify four compounds that, when elevated, are indicative of lung cancer. U L _ 3 4 3 4 UL_34 34 6 / 2 3 / 1 4 9 : 4 7 A M 6/23/14 9:47 AM