Ashok Prabhu Masilamani

Background/Objectives: Breast cancer is the most common malignancy among women, and early detection is critical for improving outcomes. The Breast Imaging Reporting and Data System (BI-RADS) standardizes reporting, but the BI-RADS 4 category presents a major challenge, with malignancy risk ranging from 2% to 95%. Consequently, most women in this category undergo biopsies that ultimately prove unnecessary. This study evaluated whether exhaled breath analysis could distinguish malignant from benign findings in BI-RADS 4 patients. Methods: Participants referred to the McGill University Health Centre Breast Center with BI-RADS 3–5 findings provided multiple breath specimens. Breathprints were captured using an electronic nose (eNose) powered breathalyzer, and diagnoses were confirmed by imaging and pathology. An autoencoder-based model fused the breath data with BI-RADS scores to predict malignancy. Model performance was assessed using repeated cross-validation with ensemble voting, prioritizing sensitivity to minimize false negatives. Results: The breath specimens of eighty-five participants, including sixty-eight patients with biopsy-confirmed benign lesions and seventeen patients with biopsy-confirmed breast cancer within the BI-RADS 4 cohort were analyzed. The model achieved a mean sensitivity of 88%, specificity of 75%, and a negative predictive value (NPV) of 97%. Results were consistent across BI-RADS 4 subcategories, with particularly strong sensitivity in higher-risk groups. Conclusions: This proof-of-concept study shows that exhaled breath analysis can reliably differentiate malignant from benign findings in BI-RADS 4 patients. With its high negative predictive value, this approach may serve as a non-invasive rule-out tool to reduce unnecessary biopsies, lessen patient burden, and improve diagnostic decision-making. Larger, multi-center studies are warranted.

Background/Objectives: Breast cancer is the most common malignancy among women, and early detection is critical for improving outcomes. The Breast Imaging Reporting and Data System (BI-RADS) standardizes reporting, but the BI-RADS 4 category presents a major challenge, with malignancy risk ranging from 2% to 95%. Consequently, most women in this category undergo biopsies that ultimately prove unnecessary. This study evaluated whether exhaled breath analysis could distinguish malignant from benign findings in BI-RADS 4 patients. Methods: Participants referred to the McGill University Health Centre Breast Center with BI-RADS 3–5 findings provided multiple breath specimens. Breathprints were captured using an eNose powered breathalyzer , and diagnoses were confirmed by imaging and pathology. An autoencoder-based model fused the breath data with BI-RADS scores to predict malignancy. Model performance was assessed using repeated cross-validation with ensemble voting, prioritizing sensitivity to minimize false negatives. Results: The breath specimens of eighty-five participants, including sixty-eight patients with biopsy-confirmed benign lesions and seventeen patients with biopsy-confirmed breast cancer within the BI-RADS 4 cohort are analyzed. The model achieved a mean sensitivity of 88%, specificity of 75%, and a negative predictive value of 97%. Results were consistent across BI-RADS 4 subcategories, with particularly strong sensitivity in higher-risk groups. Conclusions: This proof-of-concept study shows that exhaled breath analysis can reliably differentiate malignant from benign findings in BI-RADS 4 patients. With its high negative predictive value, this approach may serve as a non-invasive rule-out tool to reduce unnecessary biopsies, lessen patient burden, and improve diagnostic decision-making. Larger, multi-center studies are warranted.

Confounding factors in olfactory aroma data, such as high humidity levels, substantially affect sensor outputs, masking subtle volatile organic compound (VOC) patterns and hindering generalizable machine learning models. Traditional representation learning methods often require large datasets to mitigate confounder-induced variance, a resource unavailable in specialized sensor applications with limited data. This study presents Confounder-Invariant Representation Learning (CIRL), a method designed to mitigate confounding influences in data-scarce settings by leveraging explicit confounder information, such as relative humidity. CIRL enhances learned representations by reducing confounder effects, improving data purity and model robustness. Applied to three breath aroma datasets—acetone, ketosis, and peppermint-oil breath, all affected by high humidity—CIRL was integrated with standard autoencoder models. Evaluated within the same framework, CIRL improved generalization performance by 10–15% in classification accuracy across all three datasets. These results demonstrate CIRL’s potential to advance reliable artificial olfaction for applications like breath-based diagnostics in challenging real-world conditions.

Confounding factors in olfactory aroma data, such as high humidity levels, substantially affect sensor outputs, masking subtle volatile organic compound (VOC) patterns and hindering generalizable machine learning models. Traditional representation learning methods often require large datasets to mitigate confounder-induced variance, a resource unavailable in specialized sensor applications with limited data. This study presents Confounder-Invariant Representation Learning (CIRL), a method designed to mitigate confounding influences in data-scarce settings by leveraging explicit confounder information, such as relative humidity. CIRL enhances learned representations by reducing confounder effects, improving data purity and model robustness. Applied to three breath aroma datasets—acetone, ketosis, and peppermint-oil breath, all affected by high humidity—CIRL was integrated with standard autoencoder models. Evaluated within the same framework, CIRL improved generalization performance by 10–15% in classification accuracy across all three datasets. These results demonstrate CIRL’s potential to advance reliable artificial olfaction for applications like breath-based diagnostics in challenging real-world conditions.

Monitoring the effectiveness of statin therapy in patients with dyslipidemia is essential for ensuring optimal treatment outcomes. The current standard involves lipid profiling via blood tests to detect abnormalities in blood lipids. This study evaluated the feasibility of a non-invasive, breath-based approach to statin therapy monitoring using Noze’s electronic nose (eNose) platform. A total of 35 participants were enrolled, 25 with elevated low-density lipoprotein cholesterol (LDL-C) levels and 10 healthy controls. The high LDL-C group provided breath specimens both before starting statin therapy and after 6 to 8 weeks of treatment. These breath specimens were digitized using Noze’s eNose platform and analyzed using machine learning (ML) algorithms. Results showed a 91% sensitivity and 87% specificity in identifying high blood cholesterol cases, demonstrating the potential of Noze’s eNose platform for non-invasive monitoring of statin therapy through exhaled breath.

Breast cancer is the most commonly diagnosed cancer worldwide, underscoring the critical need for effective early detection methods to reduce mortality. Traditional detection techniques, such as mammography, present significant limitations, particularly in women with dense breast tissue, highlighting the need for alternative screening approaches. Breathomics, based on the analysis of Volatile Organic Compounds (VOCs) present in exhaled breath, offers a non-invasive, potentially transformative diagnostic tool. These VOCs are metabolic byproducts from various organs of the human body whose presence and varying concentrations in breath are reflective of different health conditions. This review explores the potential of breathomics, highlighting its promise as a rapid, cost-effective screening approach for breast cancer, facilitated through the integration of portable solutions like electronic noses (e-noses). Key considerations for clinical translation—including patient selection, environmental confounders, and different breath collection methods—will be examined in terms of how each of them affects the breath profile. However, there are also challenges such as patient variability in VOC signatures, and the need for standardization in breath sampling protocols. Future research should prioritize standardizing sampling and analytical procedures and validating their clinical utility through large-scale clinical trials.

Breast cancer is the most commonly diagnosed cancer worldwide [1], underscoring the critical need for effective early detection methods to reduce mortality. Traditional detection techniques, such as mammography, present significant limitations, particularly in women with dense breast tissue, highlighting the need for alternative screening approaches. Breathomics, based on the analysis of volatile organic compounds (VOCs) present in exhaled breath, offers a non-invasive, potentially transformative diagnostic tool. These VOCs are metabolic byproducts from various organs of the human body whose presence and varying concentrations in breath are reflective of different health conditions. This review explores the potential of breathomics, highlighting its promise as a rapid, cost-effective screening approach for breast cancer, facilitated through the integration of portable solutions like electronic noses (e-noses). Key considerations for clinical translation - including patient selection, environmental confounders, and different breath collection methods will be examined in terms of how each of them affects the breath profile. However, there are also challenges such as patient variability in VOC signatures, and the need for standardization in breath sampling protocols. Future research should prioritize standardizing sampling and analytical procedures, and validating their clinical utility through large-scale clinical trials.