ArticleInternational journal of cancer2026
Clinical Utility of Cytological Methylation Assay in Cervical Cancer Screening Across Various Cervical Transformation Zones.
Article in International journal of cancer, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Type I to III cervical transformation zones (TZ-1 to TZ-3) may have various effects on cervical cancer screening and diagnostic outcomes. This study aims to evaluate the clinical utility of the cytological PAX1/JAM3 methylation (CISCER) assay in cervical cancer screening, especially in TZ-3 women. Between November 2020 and October 2022, 1782 women referred for colposcopy underwent liquid-based cytology (LBC), high-risk human papillomavirus (hrHPV) genotyping, and CISCER testing. After applying inclusion criteria, 1398 women were analyzed, including 1190 with documented TZ classification. Diagnostic performance for detecting cervical intraepithelial neoplasia grade 3 or worse (CIN3+) was compared across TZ subgroups. For CIN3+ detection, CISCER showed sensitivities of 67.4%, 72.0%, 48.3%, and 81.5% and specificities of 91.0%, 94.2%, 91.3%, and 89.8% in all women, TZ-1, TZ-2, and TZ-3, respectively. Compared with LBC ≥ ASC-US, hrHPV positivity, or HPV16/18 positivity, CISCER achieved the highest diagnostic accuracy, with AUC values of 0.792, 0.831, 0.698, and 0.856 across the respective groups. In both the overall cohort and TZ-3 subgroup, CISCER positivity was associated with the highest CIN3+ risk (34.6% and 31.4%) and required the fewest colposcopy referrals per CIN3+ detected (2.9 and 3.2). Combining hrHPV testing with CISCER further improved risk stratification. CISCER demonstrated superior diagnostic performance across TZ types, particularly in TZ-3, enabling improved CIN3+ risk discrimination while substantially reducing unnecessary colposcopy referrals compared with conventional cytology and HPV genotyping.
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