Protecting Patients from Progression
The first molecular prognostic test for cervical dysplasia may help determine the need for treatment
Michael Schubert | | Quick Read
For patients who receive a diagnosis of cervical dysplasia, the future can be uncertain. Many cases resolve without treatment, but some progress to cancer. Deciding whether or not to undergo surgery – which carries risks to the patient’s sexual and psychological wellbeing and to potential future pregnancies – is challenging and, until now, there has been no way to predict which cases are most likely to progress.
Attila Lorincz, a researcher at Queen Mary University of London, seeks to change that with a molecular test. He and his colleagues applied the S5 DNA methylation panel to cervical cells from 149 patients with moderate (CIN2) cervical dysplasia (1). The test examines the methylation levels of specific target genes; patients who exhibit increased methylation are more likely to see a progression of disease. “The S5 test worked very well for other applications, such as finding severe disease that was missed by other tests,” Lorincz explains. “Therefore, it was reasonable to see if S5 could determine the risk for progression of moderate dysplasia to severe disease.”
The researchers also examined the sensitivity of testing via cytology or human papillomavirus genotyping. Of the three, the S5 classifier was the strongest single biomarker for predicting progression or persistence versus regression. So when might it begin showing up in laboratories? “The test needs to go into routine manufacturing and be proven safe and effective in studies directed to regulatory agencies. When approved by these oversight bodies, the test can become widely available to women on a routine basis,” says Lorincz. “I hope the test will reduce overtreatment of women with moderate cervical dysplasia, and eventually also reduce treatment of severe dysplasia.”
- K Louvanto et al., “Methylation in predicting progression of untreated high-grade cervical intraepithelial neoplasia”, Clin Infect Dis, [Epub ahead of print] (2019). PMID: 31344234.