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      Intra‐ and inter‐laboratory agreement of the FAM19A4/mir124‐2 methylation test: Results from an international study

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          Abstract

          Background

          HPV‐based cervical screening detects women at an increased risk of cervical cancer and precancer. To differentiate among HPV‐positive women those with (pre)cancer, triage testing is necessary. The detection of cancer‐associated host‐cell DNA methylation ( FAM19A4 and hsa‐ mir124‐2) in cervical samples has shown valuable as triage test. This multicenter study from 6 collaborating European laboratories and one reference laboratory was set out to determine the intra‐ and inter‐laboratory agreement of FAM19A4/ mir124‐2 DNA methylation analysis utilizing the QIAsure Methylation Test.

          Methods

          Agreement analysis for the QIAsure Methylation Test was assessed on high‐risk HPV‐positive cervical specimens (n = 1680) both at the level of the assay and at the full workflow, including bisulfite conversion.

          Results

          Intra‐ and inter‐laboratory assay agreement were 91.4% (534/584; 95% CI 88.9‐93.5; κ = 0.82) and 92.5% (369/399; 95% CI 90.0‐94.7; κ = 0.83), respectively. The inter‐laboratory workflow (bisulfite conversion and assay combined) agreement was 90.0% (627/697; 95% CI 87.5%‐92.0%; κ = 0.76).

          Conclusion

          These data show that the QIAsure Methylation Test performs robust and reproducible in different laboratory contexts. These results support the use of the QIAsure Methylation Test for full molecular screening for cervical cancer, including primary HPV testing and triage testing by methylation analysis.

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          Most cited references13

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          Clinical implications of (epi)genetic changes in HPV-induced cervical precancerous lesions.

          Infection of cervical epithelium with high-risk human papilloma virus (hrHPV) might result in productive or transforming cervical intraepithelial neoplasia (CIN) lesions, the morphology of which can overlap. In transforming CIN lesions, aberrations in host cell genes accumulate over time, which is necessary for the ultimate progression to cancer. On the basis of (epi)genetic changes, early and advanced transforming CIN lesions can be distinguished. This paves the way for new molecular tools for cervical screening, diagnosis and management of cervical cancer precursor lesions.
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            Guidelines for human papillomavirus DNA test requirements for primary cervical cancer screening in women 30 years and older.

            Given the strong etiologic link between high-risk HPV infection and cervical cancer high-risk HPV testing is now being considered as an alternative for cytology-based cervical cancer screening. Many test systems have been developed that can detect the broad spectrum of hrHPV types in one assay. However, for screening purposes the detection of high-risk HPV is not inherently useful unless it is informative for the presence of high-grade cervical intraepithelial neoplasia (CIN 2/3) or cancer. Candidate high-risk HPV tests to be used for screening should reach an optimal balance between clinical sensitivity and specificity for detection of high-grade CIN and cervical cancer to minimize redundant or excessive follow-up procedures for high-risk HPV positive women without cervical lesions. Data from various large screening studies have shown that high-risk HPV testing by hybrid capture 2 and GP5+/6+-PCR yields considerably better results in the detection of CIN 2/3 than cytology. The data from these studies can be used to guide the translation of high-risk HPV testing into clinical practice by setting standards of test performance and characteristics. On the basis of these data we have developed guidelines for high-risk HPV test requirements for primary cervical screening and validation guidelines for candidate HPV assays. Copyright (c) 2008 Wiley-Liss, Inc.
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              Interobserver reproducibility of cervical cytologic and histologic interpretations: realistic estimates from the ASCUS-LSIL Triage Study.

              Despite a critical presumption of reliability, standards of interpathologist agreement have not been well defined for interpretation of cervical pathology specimens. To determine the reproducibility of cytologic, colposcopic histologic, and loop electrosurgical excision procedure (LEEP) histologic cervical specimen interpretations among multiple well-trained observers. The Atypical Squamous Cells of Undetermined Significance-Low-grade Squamous Intraepithelial Lesion (ASCUS-LSIL) Triage Study (ALTS), an ongoing US multicenter clinical trial. From women enrolled in ALTS during 1996-1998, 4948 monolayer cytologic slides, 2237 colposcopic biopsies, and 535 LEEP specimens were interpreted by 7 clinical center and 4 Pathology Quality Control Group (QC) pathologists. kappa Values calculated for comparison of the original clinical center interpretation and the first QC reviewer's masked interpretation of specimens. For all 3 specimen types, the clinical center pathologists rendered significantly more severe interpretations than did reviewing QC pathologists. The reproducibility of monolayer cytologic interpretations was moderate (kappa = 0.46; 95% confidence interval [CI], 0.44-0.48) and equivalent to the reproducibility of punch biopsy histopathologic interpretations (kappa = 0.46; 95% CI, 0.43-0.49) and LEEP histopathologic interpretations (kappa = 0.49; 95% CI, 0.44-0.55). The lack of reproducibility of histopathology was most evident for less severe interpretations. Interpretive variability is substantial for all types of cervical specimens. Histopathology of cervical biopsies is not more reproducible than monolayer cytology, and even the interpretation of LEEP results is variable. Given the degree of irreproducibility that exists among well-trained pathologists, realistic performance expectations should guide use of their interpretations.
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                Author and article information

                Contributors
                dam.heideman@vumc.nl
                Journal
                J Clin Lab Anal
                J. Clin. Lab. Anal
                10.1002/(ISSN)1098-2825
                JCLA
                Journal of Clinical Laboratory Analysis
                John Wiley and Sons Inc. (Hoboken )
                0887-8013
                1098-2825
                13 February 2019
                May 2019
                : 33
                : 4 ( doiID: 10.1002/jcla.2019.33.issue-4 )
                : e22854
                Affiliations
                [ 1 ] Self‐screen B.V Amsterdam the Netherlands
                [ 2 ] Institute of Microbiology and immunology University of Ljubljana Ljubljana Slovenia
                [ 3 ] HPV Research Group, Division of Pathology University of Edinburgh Edinburgh Scotland
                [ 4 ] Institute for clinical chemistry, laboratory and transfusion medicine Wolfsburg Germany
                [ 5 ] Molecular Pathology Laboratory, Department of Pathology Hvidovre Hospital Hvidovre Denmark
                [ 6 ] Infections and Cancer Laboratory Catalan Institute of Oncology (ICO) Barcelona Spain
                [ 7 ] DDL Diagnostic Laboratory Rijswijk the Netherlands
                [ 8 ] Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam Amsterdam the Netherlands
                Author notes
                [*] [* ] Correspondence

                Daniëlle A.M. Heideman, Amsterdam UMC, Vrije Universiteit Amsterdam, Pathology, Cancer Center Amsterdam, Amsterdam, the Netherlands.

                Email: dam.heideman@ 123456vumc.nl

                Article
                JCLA22854
                10.1002/jcla.22854
                6528594
                30758084
                1df05e09-3f1c-4ace-bdfc-d6310cce9b7e
                © 2019 The Authors Journal of Clinical Laboratory Analysis Published by Wiley Periodicals, Inc.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 02 October 2018
                : 29 November 2018
                : 21 December 2018
                Page count
                Figures: 0, Tables: 7, Pages: 7, Words: 4687
                Funding
                Funded by: Horizon 2020 Work Programme of the European Commission
                Award ID: 666800
                Categories
                Research Article
                Research Articles
                Custom metadata
                2.0
                jcla22854
                May 2019
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.7.0 mode:remove_FC converted:24.10.2019

                Clinical chemistry
                cervical cancer,cervical intraepithelial neoplasia,host‐cell dna methylation,hpv,qiasure methylation test,reproducibility,triage

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