Cytological DNA methylation for cervical cancer screening: a validation set

Triage performance of DNA methylation for women with high-risk human papillomavirus infection

OBJECTIVE

DNA methylation is a promising biomarker for cervical cancer screening. This study aimed to validate the triage performance of cytological DNA methylation for detecting cervical intraepithelial neoplasia of grade 3 or worse (CIN3+) in women with high-risk human papillomavirus (hrHPV) infection from a large prospective cohort undergoing opportunistic screening in China (METHY3).

METHODS

The triage performance for detecting CIN3+ lesions was compared between HPV16/18 genotyping, a liquid-based cytology (LBC) test, and the PAX1 and JAM3 methylation (PAX1m/JAM3m) test according to cervical pathologic outcomes. Among the 4394 women infected with hrHPV, 1105 had definitive cervical histological findings that were analyzed.

RESULTS

For detecting CIN3+, the specificity of HPV16/18(+), the LBC result of ≥atypical squamous cells of undetermined significance (ASCUS), and PAX1m/JAM3m(+) was 66.4%, 23.9%, and 89.6%, respectively, with odds ratios of 4.24 (95% confidence interval [CI], 2.85-6.40), 4.44 (2.27-10.1), and 18.5 (12.1-28.7) (P < .001), respectively. PAX1m/JAM3m(+) had the highest area under the receiver operating characteristic curve (0.790, 95% CI, 0.747-0.832) in the whole cohort and in women of various ages. PAX1m/JAM3m (+) was detected in all patients with cancer (n = 28). Compared with HPV16/18 genotyping and the LBC test, PAX1m/JAM3m testing reduced referrals to colposcopy by 20.64 percentage points and 61.18 percentage points, respectively.

CONCLUSIONS

PAX1 m /JAM3 m testing is highly specific for detecting CIN3+. As a triage biomarker, it is superior to HPV 16/18 genotyping and LBC testing for women with hrHPV infection.

Advances in cervical cancer: current insights and future directions

In alignment with the World Health Organization's strategy to eliminate cervical cancer, substantial progress has been made in the treatment of this malignancy. Cervical cancer, largely driven by human papillomavirus (HPV) infection, is considered preventable and manageable because of its well-established etiology. Advancements in precision screening technologies, such as DNA methylation triage, HPV integration detection, liquid biopsies, and artificial intelligence-assisted diagnostics, have augmented traditional screening methods such as HPV nucleic acid testing and cytology. Therapeutic strategies aimed at eradicating HPV and reversing precancerous lesions have been refined as pivotal measures for disease prevention. The controversy surrounding surgery for early-stage cervical cancer revolves around identifying optimal candidates for minimally invasive and conservative procedures without compromising oncological outcomes. Recent clinical trials have yielded promising results for the development of systemic therapies for advanced cervical cancer. Immunotherapies, such as immune checkpoint inhibitors (ICIs), antibody-drug conjugates (ADCs), and targeted therapy have demonstrated significant effectiveness, marking a substantial advancement in cervical cancer management. Various combination therapies have been validated, and ongoing trials aim to enhance outcomes through the development of novel drugs and optimized combination regimens. The prospect of eradicating cervical cancer as the first malignancy to be eliminated is now within reach. In this review, we provide a comprehensive overview of the latest scientific insights, with a particular focus on precision managements for various stages of cervical disease, and explore future research directions in cervical cancer.

Assessment of PAX1 and JAM3 methylation triage efficacy across HPV genotypes and age groups in high-risk HPV-positive women in China

Objective

This study aimed to evaluate the clinical utility of PAX1/JAM3 methylation (CISCER) test in triaging high-risk human papillomavirus (hrHPV)-positive women.

Methods

We enrolled women who underwent opportunistic screening at Cervical Disease outpatient clinics of Xuzhou Maternity and Child Health Hospital, and Yueyang Central Hospital from December 2022 to May 2024. The effectiveness of CISCER and cytology tests in triaging hrHPV+ patients was analyzed.

Results

Among the 436 study participants, 283 (64.9%) had no cervical intraepithelial neoplasia (CIN), while 53 (12.2%) had CIN1, 40 (9.2%) had CIN2, 34 (7.8%) had CIN3, and 26 (5.9%) had cervical cancers. The CISCER tests identified all cases of cervical cancer, particularly 2 hrHPV-negative adenocarcinoma cases. In 396 hrHPV+ individuals, the sensitivity of CISCER tests for detecting CIN2+ lesions was 92.6% (95% CI: 87.2-97.9%), with a specificity of 95.7% (95% CI: 93.4-98%), and an area under the receiver operating characteristic curve (AUC) of 0.941 (95% CI: 0.903-0.979), outperforming cytology tests in both HPV16/18+ and non-16/18 hrHPV+ women. Notably, CISCER demonstrated 100% (95% CI: 90-100%) sensitivity in women aged≥50 and 100% (95%CI: 93.6-100%) specificity in women aged<30. Among CIN2+ women, 37.2% (including 3 cancer) showed low-grade cytological changes that could be detected by CISCER. Meanwhile, 52% of CIN2- women exhibited cytological abnormalities but had negative CISCER results. The immediate CIN3+ risk based on positive CISCER results was 54% (95% CI: 43.8-63.9%).

Conclusion

The PAX1/JAM3 methylation detection using cervical exfoliated cells showed superior triage performance for hrHPV-positive patients compared to traditional strategies.

Diagnostic Accuracy of DNA-Methylation in Detection of Cervical Dysplasia: Findings from a Population-Based Screening Program

BACKGROUND

Epigenetic biomarkers in cancer have emerged as promising tools for early detection, prognosis, and treatment response prediction. In cervical cells, hypermethylation of the host and viral HPV-genome increases with the severity of lesions, providing a useful biomarker in the triage of hr-HPV-positive women and during treatment. The present study focuses on evaluating the clinical performance of the FAM19A4/miR124-2 methylation test in a population-based cervical screening program.

METHODS

Previously collected cervical samples, after bisulfite-converted DNA, were analyzed by PreCursor-M+ kit (distributed by Fujirebio Europe), for DNA methylation. The sensitivity, specificity, and negative/positive predictive values of DNA methylation were compared to histology, colposcopy, the HPV-DNA test, and cytology results.

RESULTS

Among the 61-sample set, the specificity of methylation vs. positive histology (≥CIN2) and colposcopy (≥G2) were 87% and 90%, whereas the sensitivity was 50% and 33.3%, respectively. The combination of methylation analysis with standard methods increases diagnostic accuracy.

CONCLUSIONS

Overall, we found a good specificity of DNA methylation in comparison to currently used techniques. Further larger studies could support the use of FAM19A4/miR124-2 as reliable biomarkers in the prevention of cervical cancer as triage in the screening protocol.

The research progress on radiation resistance of cervical cancer

Cervical carcinoma is the most prevalent gynecology malignant tumor and ranks as the fourth most common cancer worldwide, thus posing a significant threat to the lives and health of women. Advanced and early-stage cervical carcinoma patients with high-risk factors require adjuvant treatment following surgery, with radiotherapy being the primary approach. However, the tolerance of cervical cancer to radiotherapy has become a major obstacle in its treatment. Recent studies have demonstrated that radiation resistance in cervical cancer is closely associated with DNA damage repair pathways, the tumor microenvironment, tumor stem cells, hypoxia, cell cycle arrest, and epigenetic mechanisms, among other factors. The development of tumor radiation resistance involves complex interactions between multiple genes, pathways, and mechanisms, wherein each factor interacts through one or more signaling pathways. This paper provides an overview of research progress on an understanding of the mechanism underlying radiation resistance in cervical cancer.