Cytojournal · 2024;21:15 · Case-Control · Northwest China

CDO1/CELF4 Methylation for EC in Postmenopausal Bleeding

The endometrial cancer detection using non-invasive hypermethylation of CDO1 and CELF4 genes in women with postmenopausal bleeding in Northwest China
138 PMB women (40 EC) · Se 87.5% / Sp 95.9% · CDO1m AUC 0.932 · 100% of type II EC detected · Gansu Province
Cai B, Du J, Wang Y, Liu Z, Wang Y, Li L, Liu P, Wang L, Liu Q, Meng Z
Gansu Provincial Maternity & Child-care Hospital · Cytojournal 2024;21:15 · doi:10.25259/Cytojournal_78_2023
138
PMB women (40 EC)
87.5%
Sensitivity
95.9%
Specificity
0.932
CDO1m AUC

1Background & Objective

  • Problem: PMB affects ≤10% women; EC incidence rising in NW China (Gansu GDP rank 27/31) — needs low-cost triage.
  • Objective: validate CDO1m/CELF4m in PMB women to triage before invasive hysteroscopy/D&C.

2Study Design & Cohort

40
EC (29%)
98
non-EC (71%)
58y
median age
  • Setting: Gansu Provincial MCH Hospital; prospective case-control, 2022.
  • Assays: cervical cells → qPCR CDO1m/CELF4m; TVUS ET; BMI; CA125.
  • Reference: hysteroscopy biopsy / D&C histopathology = gold standard.
  • Age balance: EC vs non-EC P=0.492 (no confound).
80%
FIGO I
85%
type I EC
15%
type II (n=6)
45%
G1
30%
G2
25%
G3
  • PMB context: ~2/3 of postmenopausal gynecologic visits; EC must be ruled out.
  • Assay logic: methylation(+) → invasive confirm; (−) → benign, monitor.
  • Inclusion: postmenopausal PMB; BMI + TVUS + CA125 + methylation complete.
  • Exclusion: prior treatment · other malignancy · invalid samples.
  • Statistics: Se/Sp/accuracy · ROC/AUC · case-control comparison.
  • Design note: biopsy/D&C under hysteroscopy as gold standard.
87.5%
Se · dual
95.9%
Sp · dual
0.932
CDO1m AUC
Type II = 2 clear cell · 2 serous · 2 mixed — all 6 detected by methylation; EC vs non-EC age ns (P=0.492).

3AUC Ladder — Methylation vs Others

CDO1m
0.932
CELF4m
0.863
CA125
0.704
ET (TVUS)
0.672
BMI
0.656
  • Methylation on top: CDO1m AUC 0.932 ≫ CA125/ET/BMI.

4ROC & Dual-Gene Performance

ROC curves CDO1m CELF4m CA125 ET BMI
Fig. ROC — CDO1m 0.932 > CELF4m 0.863 > CA125 0.704 > ET 0.672 > BMI 0.656.
87.5%
Se · dual
95.9%
Sp · dual
  • High specificity: 95.9% — few false positives for invasive work-up.
  • Type II 100%: all 6 aggressive EC detected by methylation.

5Stage & Type Coverage

FIGO I
80%
Type II EC
100% detected
  • Early-stage focus: 80% stage I — screening catches curable disease.
  • Aggressive types: type II (serous/clear/mixed) all methylation(+).
  • Cost fit: simple qPCR — feasible for resource-limited NW China.
Clinical Significance