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This study aimed to assess the diagnostic-support and triage value of PAX1/JAM3 methylation testing for identifying high-grade cervical lesions among postmenopausal women referred for colposcopy. A total of 216 women aged ≥50 years who underwent colposcopy due to positive high-risk human papillomavirus (hrHPV)/cytology detection and/or abnormal clinical symptoms were included, and 212 women aged <50 years matched 1:1 by hrHPV and cytology results as the control group. The effectiveness of PAX1/JAM3 methylation in detecting high-grade cervical intraepithelial neoplasia (CIN) was compared to traditional screening methods. PAX1/JAM3 methylation showed a sensitivity of 93.2%85.7%-100% for detecting CIN2+ lesions (97.2%91.9%-100% for CIN3+), with a specificity of 93.6%89.9%-97.3% for CIN1-lesions, outperforming liquid-based cytology (LBC) (CIN2+/CIN3+ sensitivity: 75%60.9%-89.1%; specificity: 52.3%44.9%-59.8%) and the combination of LBC and hrHPV tests according to current guidelines (CIN2+/CIN3+ sensitivity: 81.8%70.4%-93.2%/83.3%71.2%-95.5%; specificity: 45.3%37.9%-52.8%). Methylation detection successfully identified two adenocarcinoma cases with negative hrHPV and LBC, as well as 7 patients with non-16/18 hrHPV infection that were missed by LBC. The methylation levels of PAX1 and JAM3 were elevated in elderly women with CIN2+ compared to younger women, and showed no association with HPV types. In conclusion, PAX1/JAM3 methylation testing showed promising diagnostic-support performance among postmenopausal women referred for colposcopy, suggesting potential utility as a supplementary detection method to improve diagnostic accuracy in older women.
Li et al. (Fri,) studied this question.