Methylation analysis and HPV genotyping of self-collected cervical samples from women not responding to screening invitation and review of the literature

Annarosa Del Mistro, Helena Frayle, Martina Rizzi, Gianpiero Fantin, Antonio Ferro, Paolo Matteo Angeletti, Paolo Giorgi Rossi, Emma Altobelli, Annarosa Del Mistro, Helena Frayle, Martina Rizzi, Gianpiero Fantin, Antonio Ferro, Paolo Matteo Angeletti, Paolo Giorgi Rossi, Emma Altobelli

Abstract

Aim of the study: To assess the feasibility of partial HPV genotyping and methylation analysis of CADM1, MAL, and miR124-2 genes as triage tests in assaying self-collected cervical samples positive for high-risk HPV on primary screening, and to review the literature regarding host cellular gene methylation analysis of self-collected cervical samples.

Material and methods: Women residing in North-East Italy who had failed to respond to the invitation to participate in an organized population-based program were invited to provide a self-sample. Their stored baseline (self-collected) and follow-up (clinician-collected) cervical samples were included in the study. DNA was extracted from HPV-positive (Qiagen's Hybrid Capture 2, HC2) samples. Partial genotyping with separate detection of HPV types 16 and 18 was performed with a hybrid capture-based method and a quantitative PCR assay. Methylation was assayed with a quantitative methylation-specific PCR.

Results: High-risk HPV infection was detected in 48% of baseline and 71% of follow-up HC2-positive samples. Methylation was demonstrated respectively in 15% and 23.5% of baseline and follow-up samples and chiefly involved a single gene (miR124-2). Invalid quantitative PCR results were recorded in 5% of self-collected samples. The specificity of miR124-1, MAL, and CADM1 methylation was 84%, 94%, and 98%, respectively, and the specificity of the three markers combined was 84%. Sensitivity was not estimated due to the lack of CIN2+ samples. The systematic review showed that different methylation assays yield different accuracy values.

Conclusion: Self-collected samples are suitable for methylation assays included in reflex triage testing. The reproducibility and accuracy of the methylation tests described in the literature should be improved.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. PRISMA Flow-Chart: search strategy.
Fig 1. PRISMA Flow-Chart: search strategy.
Fig 2. Forrest plot: sensitivity and specificity…
Fig 2. Forrest plot: sensitivity and specificity values of each methylation assay retrieved by the systematic review and of the assay carried out in the present study.
Legend: (b): brush; (l): lavage; (ts50) threshold -50 as reported on Ref. [30]

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