title: A four-gene methylation marker panel as triage test in high-risk human papillomavirus positive patients.
abstract: Cervical neoplasia-specific biomarkers, e.g. DNA methylation markers, with high sensitivity and specificity are urgently needed to improve current population-based screening on (pre)malignant cervical neoplasia. We aimed to identify new cervical neoplasia-specific DNA methylation markers and to design and validate a methylation marker panel for triage of high-risk human papillomavirus (hr-HPV) positive patients. First, high-throughput quantitative methylation-specific PCRs (QMSP) on a novel OpenArray™ platform, representing 424 primers of 213 cancer specific methylated genes, were performed on frozen tissue samples from 84 cervical cancer patients and 106 normal cervices. Second, the top 20 discriminating methylation markers were validated by LightCycler® MSP on frozen tissue from 27 cervical cancer patients and 20 normal cervices and ROCs and test characteristics were assessed. Three new methylation markers were identified (JAM3, EPB41L3 and TERT), which were subsequently combined with C13ORF18 in our four-gene methylation panel. In a third step, our methylation panel detected in cervical scrapings 94% (70/74) of cervical cancers, while in a fourth step 82% (32/39) cervical intraepithelial neoplasia grade 3 or higher (CIN3+) and 65% (44/68) CIN2+ were detected, with 21% positive cases for ≤CIN1 (16/75). Finally, hypothetical scenario analysis showed that primary hr-HPV testing combined with our four-gene methylation panel as a triage test resulted in a higher identification of CIN3 and cervical cancers and a higher percentage of correct referrals compared to hr-HPV testing in combination with conventional cytology. In conclusion, our four-gene methylation panel might provide an alternative triage test after primary hr-HPV testing.
authors.affiliation: Department of Gynecologic Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: J J H
authors.initials: JJ
authors.lastname: Eijsink
authors.forename: Á
authors.initials: Á
authors.lastname: Lendvai
authors.forename: V
authors.initials: V
authors.lastname: Deregowski
authors.forename: H G
authors.initials: HG
authors.lastname: Klip
authors.forename: G
authors.initials: G
authors.lastname: Verpooten
authors.forename: L
authors.initials: L
authors.lastname: Dehaspe
authors.forename: G H
authors.initials: GH
authors.lastname: de Bock
authors.forename: H
authors.initials: H
authors.lastname: Hollema
authors.forename: W
authors.initials: W
authors.lastname: van Criekinge
authors.forename: E
authors.initials: E
authors.lastname: Schuuring
authors.forename: A G J
authors.initials: AG
authors.lastname: van der Zee
authors.forename: G B A
authors.initials: GB
authors.lastname: Wisman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D052685:Alphapapillomavirus / Q000235:genetics / Q000302:isolation & purification; D014408:Biomarkers, Tumor / Q000235:genetics*; D015815:Cell Adhesion Molecules / Q000235:genetics; D045744:Cell Line, Tumor; D002584:Cervix Uteri / Q000473:pathology / Q000821:virology; D003581:Cytodiagnosis / Q000379:methods; D019175:DNA Methylation; D005260:Female; D005838:Genotype; D006367:HeLa Cells; D006801:Humans; D008840:Microfilament Proteins / Q000235:genetics; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000235:genetics* / Q000821:virology; D016133:Polymerase Chain Reaction; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D019098:Telomerase / Q000235:genetics; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000235:genetics / Q000821:virology; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000235:genetics / Q000821:virology
chemical_list: D014408:Biomarkers, Tumor; D015815:Cell Adhesion Molecules; C116887:EPB41L3 protein, human; C448000:JAM3 protein, human; D008840:Microfilament Proteins; C509186:TERT protein, human; D019098:Telomerase