39 Non-invasive detection of endometrial cancer by DNA methylation analysis in urine Figure 1: DNA methylation levels of GHSR, SST, and ZIC1 in full void urine, urine sediment and urine supernatant from healthy female controls and women with endometrial cancer (EC). DISCUSSION Urine is a promising alternative for the non-invasive detection of EC. The results of this feasibility study are the first to demonstrate that EC can be detected in urine by DNA methylation analysis with high diagnostic accuracy. A systematic comparison of different urine fractions demonstrated that full void urine is most optimal for EC detection. DNA methylation analysis of GHSR, SST, and ZIC1 in full void urine all showed an excellent discriminatory power for EC detection (AUC 0.86 – 0.95). Detecting EC in urine represents an accessible method for cancer diagnosis. The collection of urine can be done in an outpatient setting or by self-sampling at home, and can easily be performed repeatedly. Moreover, urine appears to be a stable medium for 2
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