Sun Dan, Shu Changfa, Zeng Fei, Xu Dabao, Zhao Xingping
Department of Gynecology, the Third Xiangya Hospital of Central South University, No.138 Tongzipo Road, Hunan, 410013, China.
The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, China.
BMC Cancer. 2024 Dec 18;24(1):1514. doi: 10.1186/s12885-024-13299-y.
To assess the clinical value of DNA methylation measurement in exfoliated cervical cells for distinguishing high-grade squamous intraepithelial lesions (HSIL) from other cervical abnormalities.
A total of 276 patients were enrolled, and general clinical information was collected. Exfoliated cervical cells were obtained to assess human papillomavirus (HPV) infection, conduct ThinPrep cytology tests (TCT), and measure methylation levels of JAM3 (△CtJ) and PAX1 (△CtP). Logistic regression was performed to identify factors significantly associated with HSIL diagnosis. A conditional inference tree model and the area under the curve (AUC) were employed to evaluate the efficacy of JAM3 and PAX1 methylation in detecting HSIL.
Independent risk factors for HSIL diagnosis included △CtJ, △CtP, atypical squamous cells of undetermined significance (ASCUS), and HPV16 infection. The conditional inference tree indicated that 96.4% of patients were non-HSIL when △CtJ > 11.66, and 99.1% were non-HSIL when △CtP > 10.97. The diagnostic performance of △CtJ/△CtP surpassed that of TCT/HPV alone. Among six methods, the combination of △CtP, TCT, and high-risk HPV (hr-HPV) testing achieved the highest sensitivity (91.2%), positive predictive value (50.0%), negative predictive value (98.6%), and AUC (0.932).
In women with hr-HPV infection, DNA methylation analysis of cervical cytology outperformed traditional TCT or HPV testing. The combination of △CtP with TCT and HPV may offer the most accurate screening approach for HSIL.
评估宫颈脱落细胞中DNA甲基化检测在鉴别高级别鳞状上皮内病变（HSIL）与其他宫颈异常方面的临床价值。
共纳入276例患者，收集一般临床信息。获取宫颈脱落细胞以评估人乳头瘤病毒（HPV）感染情况、进行薄层液基细胞学检测（TCT），并检测JAM3（△CtJ）和PAX1（△CtP）的甲基化水平。采用逻辑回归分析确定与HSIL诊断显著相关的因素。使用条件推断树模型和曲线下面积（AUC）评估JAM3和PAX1甲基化检测HSIL的效能。
HSIL诊断的独立危险因素包括△CtJ、△CtP、意义不明确的非典型鳞状细胞（ASCUS）和HPV16感染。条件推断树显示，当△CtJ＞11.66时，96.4%的患者为非HSIL；当△CtP＞10.97时，99.1%的患者为非HSIL。△CtJ/△CtP的诊断性能优于单独的TCT/HPV。在六种方法中，△CtP、TCT和高危型HPV（hr-HPV）检测联合使用时，灵敏度最高（91.2%），阳性预测值为（50.0%），阴性预测值为（98.6%），AUC为（0.932）。
在hr-HPV感染的女性中，宫颈细胞学的DNA甲基化分析优于传统的TCT或HPV检测。△CtP与TCT和HPV联合使用可能为HSIL提供最准确的筛查方法。
