BMJ Open (Jun 2024)

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

  • John Kaldor,
  • Steven G Badman,
  • Josephine Gabuzzi,
  • Suzanne Garland,
  • Julia Brotherton,
  • Monica Molano,
  • Samuel Phillips,
  • David Hawkes,
  • Dorothy A Machalek,
  • Grace Tan,
  • Zure Kombati,
  • Gloria Munnull,
  • Marion Saville,
  • Gerald L Murray,
  • John Bolnga,
  • Andrew John Vallely,
  • Prisha Balgovind,
  • Gholamreza Haqshenas,
  • Alyssa Marie Cornall,
  • Pamela Josephine Toliman

DOI
https://doi.org/10.1136/bmjopen-2023-081282
Journal volume & issue
Vol. 14, no. 6

Abstract

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Objective 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.Design Exploratory observational study.Setting Provincial hospital, same-day cervical screen-and-treat trial, Papua New Guinea.Participants 44 hrHPV+women, with paired self/clinician-collected samples (4 squamous cell carcinomas (SCC), 19 HSIL, 4 low-grade squamous intraepithelial lesions, 17 normal).Primary and secondary outcome measures 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.Results 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%).Conclusion miR124-2/MAL methylation is a potential triage strategy for the detection of HSIL/SCC in low-income and middle-income country.