High Detection Rate for Non–Muscle-Invasive Bladder Cancer Using an Approved DNA Methylation Signature Test

Noninvasive diagnostic markers for bladder cancer are still missing. DNA methylation tests have been developed for other tumor entities, among them the GynTect test for cervical cancer diagnosis. We used the GynTect test on tissue and urine sediments from 40 patients with bladder cancer and 30 control patients. Our data showed unexpectedly high diagnostic accuracy for the detection of bladder cancer. Introduction: Cystoscopy and transurethral resection are the current reference standard tests to diagnose and histologically confirm nonemuscle-invasive bladder cancer (NMIBC). In other tumor entities (ie, colon carcinoma, cervical cancer), DNA methylation markers have been approved as diagnostic tests with high diagnostic power. In our case-control study, we used an approved molecular cervical cancer diagnostics test that includes 6 DNA methylation markers (GynTect) for the detection of bladder cancer. Patients and Methods: We included samples from 40 patients with bladder cancer and 34 control subjects. In a pilot study, we analyzed DNA methylation in 38 tumor tissues and 4 healthy ureters using methylation-specific polymerase chain reaction. Subsequently, we determined the sensitivity and specificity of the GynTect for the detection of bladder cancer in urine sediments from 40 patients with bladder cancer and 30 control subjects with benign prostatic hyperplasia or urolithiasis. Results: The markers showed very different methylation rates in the NMIBC tissues, ranging from 2.6% to 78.9%. No methylation of any of the markers was detectable in the healthy ureters. Using the urine sediments from the patients with cancer and control subjects, we found surprisingly high sensitivity and specificity for the GynTect assay (60% and 96.7%, respectively). The application of different algorithms for evaluation of the markers included in GynTect resulted in a sensitivity of <= 90% and specificity of <= 100%. Conclusion: The GynTect assay, originally designed for cervical cancer diagnostics, showed unexpectedly high diagnostic accuracy for bladder cancer detection. The inclusion of additional methylation markers might allow for the development of a suitable diagnostic marker set based on the GynTect test for NMIBC diagnostics. (C) 2019 Elsevier Inc. All rights reserved.