{Reference Type}: Journal Article
{Title}: Performance of CADM1, MAL and miR124-2 methylation as triage markers for early detection of cervical cancer in self-collected and clinician-collected samples: an exploratory observational study in Papua New Guinea.
{Author}: Molano M;Machalek DA;Tan G;Garland S;Balgovind P;Haqshenas G;Munnull G;Phillips S;Badman SG;Bolnga J;Cornall AM;Gabuzzi J;Kombati Z;Brotherton J;Saville M;Hawkes D;Kaldor J;Toliman PJ;Vallely AJ;Murray GL;
{Journal}: BMJ Open
{Volume}: 14
{Issue}: 6
{Year}: 2024 Jun 19
{Factor}: 3.006
{DOI}: 10.1136/bmjopen-2023-081282
{Abstract}: <B>OBJECTIVE: </B>WHO recommends human papillomavirus (HPV) testing for cervical screening, with triage of high-risk HPV (hrHPV) positive women. However, there are limitations to effective triage for low-resource, high-burden settings, such as Papua New Guinea. In this exploratory study, we assessed the performance of host methylation as triage tools for predicting high-grade squamous intraepithelial lesions (HSIL) in self-collected and clinician-collected samples.<BR><B>METHODS: </B>Exploratory observational study.<BR><B>METHODS: </B>Provincial hospital, same-day cervical screen-and-treat trial, Papua New Guinea.<BR><B>METHODS: </B>44 hrHPV+women, with paired self/clinician-collected samples (4 squamous cell carcinomas (SCC), 19 HSIL, 4 low-grade squamous intraepithelial lesions, 17 normal).<BR><B>METHODS: </B>Methylation levels of CADM1, MAL and miR124-2 analysed by methylation-specific PCRs against the clinical endpoint of HSIL or SCC (HSIL+) measured using liquid-based-cytology/p16-Ki67 stain.<BR><B>RESULTS: </B>In clinician-collected samples, MAL and miR124-2 methylation levels were significantly higher with increasing grade of disease (p=0.0046 and p<0.0015, respectively). miR124-2 was the best predictor of HSIL (area under the curve, AUC 0.819) while MAL of SCC (AUC 0.856). In self-collected samples, MAL best predicted HSIL (AUC 0.595) while miR124-2 SCC (AUC 0.812). Combined miR124-2/MAL methylation yielded sensitivity and specificity for HSIL+ of 90.5% (95% CI 69.6% to 98.8%) and 70% (95% CI 45.7% to 88.1%), respectively, in clinician-collected samples, and 81.8% (95% CI 59.7% to 94.8%) and 47.6% (95% CI 25.7% to 70.2%), respectively, in self-collected samples. miR124-2/MAL plus HPV16/HPV18 improved sensitivity for HSIL+ (95.2%, 95% CI 76.2% to 99.9%) but decreased specificity (55.0%, 95% CI 31.5% to 76.9%).<BR><B>CONCLUSIONS: </B>miR124-2/MAL methylation is a potential triage strategy for the detection of HSIL/SCC in low-income and middle-income country.