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. 2010 Jul;12(4):498-504.
doi: 10.2353/jmoldx.2010.090212. Epub 2010 May 20.

Methylation analysis of MLH1 improves the selection of patients for genetic testing in Lynch syndrome

Lucía Pérez-Carbonell  1 , Cristina Alenda, Artemio Payá, Adela Castillejo, Víctor M Barberá, Carmen Guillén, Estefanía Rojas, Nuria Acame, Francisco J Gutiérrez-Aviñó, Antoni Castells, Xavier Llor, Montserrat Andreu, José-Luis Soto, Rodrigo Jover
Affiliations

Methylation analysis of MLH1 improves the selection of patients for genetic testing in Lynch syndrome

Lucía Pérez-Carbonell et al. J Mol Diagn. 2010 Jul.

Abstract

Inactivation of MLH1 due to promoter hypermethylation strongly suggests a sporadic origin, providing exclusion criteria for Lynch syndrome. The aim of this study is to compare the utility of methylation analysis of MLH1 and BRAF V600E mutations for the selection of patients with MLH1 negative colorectal cancer for genetic testing. MLH1 methylation status was evaluated by MethyLight and methylation-specific MLPA (MS-MLPA) in tumor DNA from 73 colorectal cancer patients with loss of MLH1 protein expression. These tumors were analyzed for BRAF V600E mutations, and genetic testing for germline MLH1 mutations was performed in all corresponding patients. Ten patients had germline mutations in MLH1 and none of their tumors showed significant MLH1 methylation or BRAF V600E mutation. MLH1 genetic testing excluded patients by MethyLight in 47 patients (64%), by MS-MLPA in 49 (67%), and BRAF V600E mutation in only 25 patients (34%) (chi(2) P = 0.00001). Specificity was 75% for MethyLight, 78% for MS-MLPA and 40% for BRAF V600E mutation. The use of MethyLight or MS-MLPA instead of BRAF mutation resulted in a cost reduction of 41% and 45%, respectively, per every MLH1 mutation detected. Taken together, methylation analysis of MLH1 shows better performance characteristics than BRAF V600E mutation in the selection of patients for genetic testing of MLH1, especially when using MS-MLPA.

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Figures

Figure 1
Figure 1
Flow diagram for the immunohistochemical and molecular analysis performed in patients and tumors.
Figure 2
Figure 2
Analysis of cost per detected mutation using different molecular tools for patient selection.
See this image and copyright information in PMC

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