Diagnostic Performance of Electronic Nose Technology in Sarcoidosis

Iris van der Sar, Karen Moor, JC (Judith) Oppenheimer, Megan Luijendijk, Paul van Daele, Anke H. Maitland-van der Zee, Paul Brinkman, Marlies Lourens*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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BACKGROUND: Diagnosing sarcoidosis can be challenging, and a noninvasive diagnostic
method is lacking. The electronic nose (eNose) technology profiles volatile organic compounds in exhaled breath and has potential as a point-of-care diagnostic tool.
RESEARCH QUESTION: Can eNose technology be used to distinguish accurately between
sarcoidosis, interstitial lung disease (ILD), and healthy control subjects, and between
sarcoidosis subgroups?
STUDY DESIGN AND METHODS: In this cross-sectional study, exhaled breath of patients with
sarcoidosis and ILD and healthy control subjects was analyzed by using an eNose (SpiroNose). Clinical characteristics were collected from medical files. Partial least squares
discriminant and receiver-operating characteristic analyses were applied to a training and
independent validation cohort.
RESULTS: The study included 252 patients with sarcoidosis, 317 with ILD, and 48 healthy
control subjects. In the validation cohorts, eNose distinguished sarcoidosis from control
subjects with an area under the curve (AUC) of 1.00 and pulmonary sarcoidosis from other
ILD (AUC, 0.87; 95% CI, 0.82-0.93) and hypersensitivity pneumonitis (AUC, 0.88; 95% CI,
0.75-1.00). Exhaled breath of sarcoidosis patients with and without pulmonary involvement,
pulmonary fibrosis, multiple organ involvement, pathology-supported diagnosis, and
immunosuppressive treatment revealed no distinctive differences. Breath profiles differed
between patients with a slightly and highly elevated soluble IL-2 receptor level (median
cutoff, 772.0 U/mL; AUC, 0.78; 95% CI, 0.64-0.92).
INTERPRETATION: Patients with sarcoidosis can be distinguished from ILD and healthy
control subjects by using eNose technology, indicating that this method may facilitate accurate diagnosis in the future. Further research is warranted to understand the value of eNose
in monitoring sarcoidosis activity.
Original languageEnglish
Pages (from-to)P738-747
Number of pages10
Issue number3
Early online date28 Oct 2021
Publication statusPublished - 1 Mar 2022


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