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Dobson LJ, Reiff ES, Little SE, Wilkins-Haug L, Bromley B. Patient choice and clinical outcomes following positive noninvasive prenatal screening for aneuploidy with cell-free DNA (cfDNA). Prenat Diagn 2016; 36:456-62. [PMID: 26938930 DOI: 10.1002/pd.4805] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 02/26/2016] [Accepted: 02/29/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Evaluate patient choices and outcomes following positive cfDNA. METHOD Retrospective cohort study of women with positive cfDNA through two academic centers between March 2012 and December 2014. Patients were screened based on ACOG indications. Medical records reviewed for counseling, ultrasound findings, diagnostic testing, karyotype and outcome. RESULTS CfDNA was positive in 114 women; 105 singletons and 9 twin pairs. CfDNA was positive for autosomal trisomy (21, 18, 13) in 96 (84.2%) and sex chromosome aneuploidy in 18 (15.8%). Certified genetic counselors performed 95% of post-cfDNA counseling. Prenatal diagnostic testing was pursued by 71/114 (62%). Karyotype was available in 91/105 (86.7%) singletons and confirmed aneuploidy in 75/91 (82.4%); the PPV of cfDNA with any ultrasound finding was 93.6% versus 58.6% without a finding. An abnormal sonographic finding was seen in 4/16 (25%) singletons with false positive cfDNA. Fetal termination occurred in 53/79 (67%) singletons and 3/5 (60%) twins with prenatal abnormal or unknown karyotype for autosomal trisomy. Eleven fetuses (11/56, 19.6%) were terminated for suspected autosomal trisomy without karyotype confirmation. CONCLUSION Patient choices following positive cfDNA are varied. Ultrasound modifies the PPV of cfDNA. Termination rates for aneuploidy are not higher than historical controls. Recommendation for karyotype confirmation prior to termination is not universally followed. © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Lori J Dobson
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA
| | - Emily S Reiff
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA.,Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Sarah E Little
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA
| | - Louise Wilkins-Haug
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Bryann Bromley
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA.,Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA.,Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Diagnostic Ultrasound Associates, PC., Brookline, MA, USA
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302
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Lewis C, Hill M, Chitty LS. Women's Experiences and Preferences for Service Delivery of Non-Invasive Prenatal Testing for Aneuploidy in a Public Health Setting: A Mixed Methods Study. PLoS One 2016; 11:e0153147. [PMID: 27045195 PMCID: PMC4821600 DOI: 10.1371/journal.pone.0153147] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 03/24/2016] [Indexed: 12/21/2022] Open
Abstract
Non-invasive prenatal testing (NIPT) for aneuploidy is currently only available in the UK through the private sector outside of the research arena. As part of an implementation study in the UK National Health Service we conducted a mixed methods study to assess women’s experience of being offered NIPT using validated measures of decisional conflict, decisional regret and anxiety. Clinical service preferences were also explored. Women with a Down syndrome screening risk >1:1000 were invited to take part in the study and offered NIPT, NIPT and invasive testing (for women with a risk above 1:150) or no further testing. A cross-sectional survey and semi-structured interviews were conducted at two time points; at the time of testing and one month following receipt of results (or equivalent for NIPT decliners). In total, 845 questionnaires and 81 interviews were analysed. The main motivation to accept NIPT was for reassurance (30.8%). Decisional conflict occurred in a minimal number of cases (3.8%), however, none of the participants experienced decisional regret. Around a third (29.9%) of women had elevated anxiety at the time of testing, including intermediate risk women who traditionally would not be offered further testing (54.4% high risk; 20.1% medium risk), a finding supported through the qualitative interviews where prolonged or additional anxiety was found to occur in some medium risk cases. Women were overwhelmingly positive about the opportunity to have a test that was procedurally safe, accurate, reduced the need for invasive testing and identified cases of Down syndrome that might otherwise have been missed. Reassurance was identified as the main motivator for accepting NIPT, particularly amongst medium risk women, with high risk women inclined to accept NIPT to inform decisions around invasive testing. The current turnaround time for test result was identified as a key limitation. All the women interviewed thought NIPT should be adopted as part of NHS clinical practice, with the majority favouring NIPT offered as a first-line test. Our study highlights the potential that NIPT has to positively impact women’s experience of prenatal testing for aneuploidy.
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Affiliation(s)
- Celine Lewis
- Genetics and Genomic Medicine, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 1EH, United Kingdom
- * E-mail:
| | - Melissa Hill
- Genetics and Genomic Medicine, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 1EH, United Kingdom
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3BH, United Kingdom
| | - Lyn S. Chitty
- Genetics and Genomic Medicine, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 1EH, United Kingdom
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3BH, United Kingdom
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303
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Yaron Y. The implications of non-invasive prenatal testing failures: a review of an under-discussed phenomenon. Prenat Diagn 2016; 36:391-6. [DOI: 10.1002/pd.4804] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/08/2016] [Accepted: 02/29/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Yuval Yaron
- Genetic Institute, Tel Aviv Sourasky Medical Center; Tel Aviv University; Tel Aviv Israel
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304
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Giambona A, Damiani G, Leto F, Jakil C, Renda D, Cigna V, Schillaci G, Picciotto F, Nicolaides KH, Passarello C, Makrydimas G, Maggio A. Embryo-fetal erythroid cell selection from celomic fluid allows earlier prenatal diagnosis of hemoglobinopathies. Prenat Diagn 2016; 36:375-81. [DOI: 10.1002/pd.4793] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 02/08/2016] [Accepted: 02/12/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Antonino Giambona
- Unit of Hematology for Rare Diseases of Blood and Blood-forming Organs; Regional Reference Laboratory for Screening and Prenatal Diagnosis of Hemoglobinopathies; Palermo Italy
| | - Gianfranca Damiani
- Unit of Prenatal Diagnosis; Hospital Villa Sofia Cervello; Palermo Italy
| | - Filippo Leto
- Unit of Hematology for Rare Diseases of Blood and Blood-forming Organs; Regional Reference Laboratory for Screening and Prenatal Diagnosis of Hemoglobinopathies; Palermo Italy
| | - Cristina Jakil
- Unit of Prenatal Diagnosis; Hospital Villa Sofia Cervello; Palermo Italy
| | - Disma Renda
- Unit of Hematology for Rare Diseases of Blood and Blood-forming Organs; Regional Reference Laboratory for Screening and Prenatal Diagnosis of Hemoglobinopathies; Palermo Italy
| | - Valentina Cigna
- Unit of Prenatal Diagnosis; Hospital Villa Sofia Cervello; Palermo Italy
| | - Giovanna Schillaci
- Unit of Prenatal Diagnosis; Hospital Villa Sofia Cervello; Palermo Italy
| | | | | | - Cristina Passarello
- Unit of Hematology for Rare Diseases of Blood and Blood-forming Organs; Regional Reference Laboratory for Screening and Prenatal Diagnosis of Hemoglobinopathies; Palermo Italy
| | - George Makrydimas
- Obstetrics and Gynecology; Ioannina University Hospital; Ioannina Greece
| | - Aurelio Maggio
- Unit of Hematology for Rare Diseases of Blood and Blood-forming Organs; Regional Reference Laboratory for Screening and Prenatal Diagnosis of Hemoglobinopathies; Palermo Italy
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305
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Kagan KO, Hoopmann M, Singer S, Schaeferhoff K, Dufke A, Mau-Holzmann UA. Discordance between ultrasound and cell free DNA screening for monosomy X. Arch Gynecol Obstet 2016; 294:219-24. [DOI: 10.1007/s00404-016-4077-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 03/14/2016] [Indexed: 01/26/2023]
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306
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Abstract
First-trimester pregnancy evaluation using fetal and maternal parameters not only allows for diagnoses to be made early in gestation but can also assess the risk of complications that become clinically evident later in pregnancy. This evaluation makes it possible for pregnancy care to be individualized. In select cases, treatment that reduces the risk of complications can be started early in pregnancy. Even though cell free DNA is a significant advance in diagnosing fetal aneuploidy, the combination of first-trimester ultrasound and maternal serum biochemistries casts a much wider diagnostic net; therefore, the 2 technologies are best used in combination.
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Affiliation(s)
- Jiri D Sonek
- Center for Maternal-Fetal Medicine, Ultrasound, and Genetics, Fetal Medicine Foundation of USA, Wright State University, Berry Pavilion, 1 Wyoming Street, Dayton, OH 45409, USA.
| | - Karl Oliver Kagan
- Department of Gynecology and Obstetrics, Universitäts-Frauenklinik, Calwerstrasse, Tübingen 772076, Germany
| | - Kypros H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, 16-20 Windsor Walk, London SE5 8BB, UK
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307
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Abstract
Maternal plasma cell-free (cf) DNA testing has higher discriminatory power for aneuploidy than any conventional multi-marker screening test. Several strategies have been suggested for introducing it into clinical practice. Secondary cfDNA, restricted only to women with positive conventional screening test, is generally cost saving and minimizes the need for invasive prenatal diagnosis but leads to a small loss in detection. Primary cfDNA, replacing conventional screening or retaining the nuchal translucency scan, is not currently cost-effective for third-party payers. Contingent cfDNA, testing about 20% of women with the highest risks based on a conventional test, is the preferred approach.
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308
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Lee DE, Lim JH, Kim MH, Park SY, Ryu HM. Novel Epigenetic Markers on Chromosome 21 for Noninvasive Prenatal Testing of Fetal Trisomy 21. J Mol Diagn 2016; 18:378-387. [PMID: 26947512 DOI: 10.1016/j.jmoldx.2015.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 11/25/2015] [Accepted: 12/09/2015] [Indexed: 10/22/2022] Open
Abstract
Until now, fetal placenta-specific epigenetic markers for noninvasive prenatal testing of fetal trisomy 21 (T21) have been identified based only on differences in tissue-specific epigenetic characteristics between placenta and maternal blood, but these characteristics have not been validated in T21 placenta. We aimed to discover novel epigenetic markers on chromosome 21 that show a hypermethylated pattern in fetal placenta compared with blood, regardless of the presence of T21. We performed a high-resolution tiling array analysis of chromosome 21 using the methylated-CpG binding domain protein-based method. We identified 93 epigenetic regions that showed fetal placenta-specific differential methylation patterns; among these, three regions showed fetal placenta-specific methylation patterns in T21 placenta samples. The methylation patterns of these three regions in the array were confirmed by bisulfite direct sequencing. The three regions were detectable in first-trimester maternal plasma. Moreover, a combination of their methylation ratio achieved high diagnostic accuracy for noninvasive prenatal testing of fetal T21 by further statistical analysis. These three novel regions with fetal placenta-specific differential methylation patterns on chromosome 21 were identified irrespective of the presence of T21. Our findings suggest that epigenetic characteristics of markers according to the presence or absence of T21 should be considered in the development of noninvasive prenatal testing of fetal T21 using fetal placenta-specific epigenetic markers.
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Affiliation(s)
- Da Eun Lee
- Laboratory of Medical Genetics, Medical Research Institute, Cheil General Hospital and Women's Healthcare Center, Seoul, Republic of Korea
| | - Ji Hyae Lim
- Laboratory of Medical Genetics, Medical Research Institute, Cheil General Hospital and Women's Healthcare Center, Seoul, Republic of Korea
| | - Min Hyoung Kim
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Republic of Korea
| | - So Yeon Park
- Laboratory of Medical Genetics, Medical Research Institute, Cheil General Hospital and Women's Healthcare Center, Seoul, Republic of Korea.
| | - Hyun Mee Ryu
- Laboratory of Medical Genetics, Medical Research Institute, Cheil General Hospital and Women's Healthcare Center, Seoul, Republic of Korea; Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Republic of Korea.
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309
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Van Opstal D, Srebniak MI. Cytogenetic confirmation of a positive NIPT result: evidence-based choice between chorionic villus sampling and amniocentesis depending on chromosome aberration. Expert Rev Mol Diagn 2016; 16:513-20. [DOI: 10.1586/14737159.2016.1152890] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Diane Van Opstal
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, the Netherlands
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310
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Wald NJ, Bestwick JP. Prenatal reflex DNA screening for Down syndrome: enhancing the screening performance of the initial first trimester test. Prenat Diagn 2016; 36:328-31. [DOI: 10.1002/pd.4784] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/05/2016] [Accepted: 01/31/2016] [Indexed: 01/11/2023]
Affiliation(s)
- Nicholas J. Wald
- Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry; Queen Mary University London; London UK
| | - Jonathan P. Bestwick
- Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry; Queen Mary University London; London UK
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311
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Fiorentino F, Bono S, Pizzuti F, Mariano M, Polverari A, Duca S, Sessa M, Baldi M, Diano L, Spinella F. The importance of determining the limit of detection of non-invasive prenatal testing methods. Prenat Diagn 2016; 36:304-11. [DOI: 10.1002/pd.4780] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 01/07/2016] [Accepted: 01/24/2016] [Indexed: 12/12/2022]
Affiliation(s)
- Francesco Fiorentino
- GENOMA Group, Molecular Genetics Laboratory; Via di Castel Giubileo 11 00138 Rome Italy
| | - Sara Bono
- GENOMA Group, Molecular Genetics Laboratory; Via di Castel Giubileo 11 00138 Rome Italy
| | - Francesca Pizzuti
- GENOMA Group, Molecular Genetics Laboratory; Via di Castel Giubileo 11 00138 Rome Italy
| | - Martina Mariano
- GENOMA Group, Molecular Genetics Laboratory; Via di Castel Giubileo 11 00138 Rome Italy
| | - Arianna Polverari
- GENOMA Group, Molecular Genetics Laboratory; Via di Castel Giubileo 11 00138 Rome Italy
| | - Sara Duca
- GENOMA Group, Molecular Genetics Laboratory; Via di Castel Giubileo 11 00138 Rome Italy
| | - Mariateresa Sessa
- GENOMA Group, Molecular Genetics Laboratory; Via di Castel Giubileo 11 00138 Rome Italy
| | - Marina Baldi
- GENOMA Group, Molecular Genetics Laboratory; Via di Castel Giubileo 11 00138 Rome Italy
| | - Laura Diano
- GENOMA Group, Molecular Genetics Laboratory; Via di Castel Giubileo 11 00138 Rome Italy
| | - Francesca Spinella
- GENOMA Group, Molecular Genetics Laboratory; Via di Castel Giubileo 11 00138 Rome Italy
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312
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Neveling K, Tjwan Thung D, Beulen L, van Rens-Buijsman W, Gomes I, van den Heuvel S, Mieloo H, Derks-Prinsen I, Kater-Baats E, Faas BHW. Validation of two-channel sequencing-by-synthesis for noninvasive prenatal testing of fetal whole and partial chromosome aberrations. Prenat Diagn 2016; 36:216-23. [PMID: 26774010 DOI: 10.1002/pd.4777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 12/16/2015] [Accepted: 01/14/2016] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To validate Illumina's two-channel NextSeq 500 sequencing system for noninvasive prenatal testing (NIPT) of fetal whole chromosome and partial aberrations. METHODS A total of 162 plasma samples, previously sequenced for NIPT on a SOLiD 5500xl platform, were sequenced on the NextSeq 500 using 75-bp single-end sequencing, followed by analysis using the WISECONDOR algorithm. RESULTS For whole chromosome aneuploidy detection, all samples were classified correctly (in total 3× T13, 3× T18, 8× T21 and 145× euploid). Three partial aberrations (36-Mb terminal loss of 5p, 14-Mb gain on 18p and 33-Mb terminal loss of 13q) were also correctly identified. Fetal fractions in 34 male samples sequenced on both the SOLiD 5500xl and NextSeq 500 platform showed no significant difference. To test robustness, two sample sets, containing both euploid and aneuploid samples, were sequenced on different NextSeq 500 machines, revealing identical results. With unchanged laboratory flow, the NIPT turnaround time could be reduced from 15-16 calendar days to 7-8 calendar days, after switching from the SOLiD 5500xl to the NextSeq 500 platform. CONCLUSIONS The NextSeq 500 platform can be used for NIPT to detect both whole and partial chromosome aberrations. It has fast turnaround times and is suitable for mid-sized laboratories.
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Affiliation(s)
- Kornelia Neveling
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands.,Genomics Technology Center, Radboud University Medical Center, Nijmegen, The Netherlands.,Prenatal Screening Foundation Nijmegen Region, Nijmegen, The Netherlands
| | - Djie Tjwan Thung
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lean Beulen
- Prenatal Screening Foundation Nijmegen Region, Nijmegen, The Netherlands.,Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wendy van Rens-Buijsman
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands.,Genomics Technology Center, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ingrid Gomes
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Simone van den Heuvel
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands.,Genomics Technology Center, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hanneke Mieloo
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Irma Derks-Prinsen
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ellen Kater-Baats
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Brigitte H W Faas
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
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313
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Persico N, Boito S, Ischia B, Cordisco A, De Robertis V, Fabietti I, Periti E, Volpe P, Fedele L, Rembouskos G. Cell-free DNA testing in the maternal blood in high-risk pregnancies after first-trimester combined screening. Prenat Diagn 2016; 36:232-6. [DOI: 10.1002/pd.4773] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 12/30/2015] [Accepted: 01/05/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Nicola Persico
- Department of Obstetrics and Gynecology ‘L. Mangiagalli’, Fondazione IRCCS ‘Ca’ Granda; Ospedale Maggiore Policlinico; Milan Italy
| | - Simona Boito
- Department of Obstetrics and Gynecology ‘L. Mangiagalli’, Fondazione IRCCS ‘Ca’ Granda; Ospedale Maggiore Policlinico; Milan Italy
| | - Benedetta Ischia
- Department of Obstetrics and Gynecology ‘L. Mangiagalli’, Fondazione IRCCS ‘Ca’ Granda; Ospedale Maggiore Policlinico; Milan Italy
| | | | | | - Isabella Fabietti
- Department of Obstetrics and Gynecology ‘L. Mangiagalli’, Fondazione IRCCS ‘Ca’ Granda; Ospedale Maggiore Policlinico; Milan Italy
| | - Enrico Periti
- Fetal Medicine Unit; Palagi Hospital; Florence Italy
| | - Paolo Volpe
- Fetal Medicine Unit; Di Venere and Sarcone Hospitals; Bari Italy
| | - Luigi Fedele
- Department of Obstetrics and Gynecology ‘L. Mangiagalli’, Fondazione IRCCS ‘Ca’ Granda; Ospedale Maggiore Policlinico; Milan Italy
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314
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Papageorghiou AT, Khalil A, Forman M, Hulme R, Mazey R, Mousa HA, Johnstone ED, McKelvey A, Cohen KE, Risley M, Denman W, Kelly B. Clinical evaluation of the IONA test: a non-invasive prenatal screening test for trisomies 21, 18 and 13. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:188-193. [PMID: 26493543 PMCID: PMC5064629 DOI: 10.1002/uog.15791] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 10/08/2015] [Accepted: 10/13/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To evaluate the clinical accuracy of the IONA® test for aneuploidy screening. METHODS This was a multicenter blinded study in which plasma samples from pregnant women at increased risk of trisomy 21 underwent cell-free DNA analysis utilizing the IONA test. For each sample, the IONA software generated a likelihood ratio and a maternal age-adjusted probability risk score for trisomies 21, 18 and 13. All results from the IONA test were compared against accepted diagnostic karyotyping. RESULTS A total of 442 maternal samples were obtained, of which 437 had test results available for analysis and assessment of clinical accuracy. The IONA test had a detection rate of 100% for trisomies 21 (n = 43; 95% CI, 87.98-100%), 18 (n = 10; 95% CI, 58.72-100%) and 13 (n = 5; 95% CI, 35.88-100%) with cut-offs applied to likelihood ratio (cut-off > 1 considered high risk for trisomy) and probability risk score incorporating adjustment for maternal age (cut-off ≥ 1/150 considered high risk for trisomy). The false-positive rate (FPR) was 0% for trisomies 18 and 13 with both analysis outputs. For trisomy 21, a FPR of 0.3% was observed for the likelihood ratio, but became 0% with adjustment for maternal age. CONCLUSION This study indicates that the IONA test is suitable for trisomy screening in a high-risk screening population. The result-interpretation feature of the IONA software should facilitate wider implementation, particularly in local laboratories, and should be a useful addition to the current screening methods for trisomies 21, 18 and 13.
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Affiliation(s)
- A. T. Papageorghiou
- Fetal Medicine UnitSt George's University Foundation Hospitals NHS TrustLondonUK
- Nuffield Department of Obstetrics and GynaecologyJohn Radcliffe HospitalOxfordUK
| | - A. Khalil
- Fetal Medicine UnitSt George's University Foundation Hospitals NHS TrustLondonUK
| | | | - R. Hulme
- Premaitha Health plcManchesterUK
| | - R. Mazey
- Premaitha Health plcManchesterUK
| | - H. A. Mousa
- Department of Fetal and Maternal MedicineLeicester Royal InfirmaryLeicesterUK
| | - E. D. Johnstone
- Tommy's Research CentreCentral Manchester Foundation TrustManchesterUK
| | - A. McKelvey
- Fetal Medicine UnitNorfolk and Norwich University Hospitals Foundation TrustNorwichUK
| | - K. E. Cohen
- Department of Fetal MedicineLeeds General InfirmaryLeedsUK
| | | | | | - B. Kelly
- Nuffield Department of Obstetrics and GynaecologyJohn Radcliffe HospitalOxfordUK
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315
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Poon LC, Dumidrascu‐Diris D, Francisco C, Fantasia I, Nicolaides KH. IONA test for first-trimester detection of trisomies 21, 18 and 13. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:184-187. [PMID: 26387684 PMCID: PMC5064725 DOI: 10.1002/uog.15749] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 09/11/2015] [Accepted: 09/13/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To assess the potential performance of screening for fetal trisomies 21, 18 and 13 by cell-free DNA (cfDNA) analysis of maternal blood using the IONA® test. METHODS This was a nested case-control study of cfDNA analysis of maternal plasma using the IONA test. Samples were obtained at 11-13 weeks' gestation, before chorionic villus sampling, from 201 euploid pregnancies, 35 with trisomy 21, four with trisomy 18 and two with trisomy 13. Laboratory personnel were blinded to the fetal karyotype. RESULTS Probability scores for trisomies 21, 18 and 13 were given for 241/242 samples analyzed. No probability score was provided for one (0.5%) euploid pregnancy because of low fetal fraction. In all 35 cases of trisomy 21 the probability score for trisomy 21 was > 95% and the scores for trisomies 18 and 13 were ≤ 0.0001%. In all four cases of trisomy 18, the probability score for trisomy 18 was > 77% and the scores for trisomies 21 and 13 were ≤ 0.0001%. In the two cases of trisomy 13, the probability score for trisomy 13 was > 59% and the scores for trisomies 21 and 18 were ≤ 0.0001%. In the 200 euploid pregnancies with a test result, the probability score was < 0.08% for trisomy 21, < 0.001% for trisomy 18 and < 0.002% for trisomy 13. Therefore, the IONA test detected 100% of all three trisomies, with a false-positive rate of 0%. CONCLUSION The IONA test successfully differentiated all cases of trisomies 21, 18 and 13 from euploid pregnancies.
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Affiliation(s)
- L. C. Poon
- Harris Birthright Research Centre for Fetal MedicineKing's College HospitalLondonUK
| | - D. Dumidrascu‐Diris
- Harris Birthright Research Centre for Fetal MedicineKing's College HospitalLondonUK
| | - C. Francisco
- Harris Birthright Research Centre for Fetal MedicineKing's College HospitalLondonUK
| | - I. Fantasia
- Harris Birthright Research Centre for Fetal MedicineKing's College HospitalLondonUK
| | - K. H. Nicolaides
- Harris Birthright Research Centre for Fetal MedicineKing's College HospitalLondonUK
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316
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Khalil A, Rodgers M, Baschat A, Bhide A, Gratacos E, Hecher K, Kilby MD, Lewi L, Nicolaides KH, Oepkes D, Raine-Fenning N, Reed K, Salomon LJ, Sotiriadis A, Thilaganathan B, Ville Y. ISUOG Practice Guidelines: role of ultrasound in twin pregnancy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:247-63. [PMID: 26577371 DOI: 10.1002/uog.15821] [Citation(s) in RCA: 334] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 11/16/2015] [Indexed: 05/27/2023]
Affiliation(s)
- A Khalil
- Fetal Medicine Unit, St George’s Hospital, St George’s University of London, London, UK
| | - M Rodgers
- The Johns Hopkins Center for Fetal Therapy, Baltimore, MD, USA
| | - A Baschat
- The Johns Hopkins Center for Fetal Therapy, Baltimore, MD, USA
| | - A Bhide
- Fetal Medicine Unit, St George’s Hospital, St George’s University of London, London, UK
| | - E Gratacos
- Fetal Medicine Units and Departments of Obstetrics, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germaniy
| | - M D Kilby
- Centre for Women’s and Children's Health, University of Birmingham and Fetal Medicine Centre, Birmingham Women’s Foundation Trust, Birmingham, UK
| | - L Lewi
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King’s College Hospital, London, UK
| | - D Oepkes
- Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - N Raine-Fenning
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
| | - K Reed
- Twin and Multiple Births Association (TAMBA)
| | - L J Salomon
- Hopital Necker-Enfants Malades, AP-HP, Universit´e Paris Descartes, Paris, France
| | - A Sotiriadis
- Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - B Thilaganathan
- Fetal Medicine Unit, St George’s Hospital, St George’s University of London, London, UK
| | - Y Ville
- Hospital Necker-Enfants Malades, AP-HP, Université Paris Descartes, Paris, France
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317
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Bestwick JP, Wald NJ. Antenatal reflex DNA screening for trisomy 18 and trisomy 13 in addition to Down's syndrome. J Med Screen 2016; 23:171-174. [PMID: 26790709 DOI: 10.1177/0969141315617982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 10/28/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Antenatal reflex DNA screening for Down's syndrome has a high screening performance. We aimed to determine the performance of trisomy 18 and trisomy 13 reflex DNA screening when added to Down's syndrome screening. METHODS In our modelled screening protocol, women provide two samples: a serum sample for a Combined test and a plasma sample for a possible DNA test. Women with Down's syndrome, trisomy 18, or trisomy 13 Combined test risks above a single cut-off have a reflex DNA test using the plasma sample, without the need to recall them to collect another sample and provide counselling. Women with a failed DNA test (after a second attempt using a fresh plasma sample) have an Integrated test, and are classified as positive if any of the Down's syndrome, trisomy 18, or trisomy 13 Integrated test risks are greater than 1 in 25. RESULTS At 1 in 800 term risk cut-offs for Down's syndrome, trisomy 18, and trisomy 13, an estimated 10% of women are reflexed to DNA screening, yielding a 91% Down's syndrome detection rate, an 89% trisomy 18 detection rate, and a 79% trisomy 13 detection rate for a 0.05% false-positive rate. At a 1 in 1900 term risk cut-off for Down's syndrome, trisomy 18, or trisomy 13, an estimated 20% of women are reflexed to DNA screening, and this yields a 94% Down's syndrome detection rate, a 92% trisomy 18 detection rate, and an 84% trisomy 13 detection rate for a 0.10% false-positive rate. CONCLUSION Reflex DNA screening for trisomies 18 and 13 can be usefully added to reflex DNA screening for Down's syndrome.
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Affiliation(s)
- Jonathan P Bestwick
- Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, UK
| | - Nicholas J Wald
- Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, UK
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318
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Taylor-Phillips S, Freeman K, Geppert J, Agbebiyi A, Uthman OA, Madan J, Clarke A, Quenby S, Clarke A. Accuracy of non-invasive prenatal testing using cell-free DNA for detection of Down, Edwards and Patau syndromes: a systematic review and meta-analysis. BMJ Open 2016; 6:e010002. [PMID: 26781507 PMCID: PMC4735304 DOI: 10.1136/bmjopen-2015-010002] [Citation(s) in RCA: 223] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To measure test accuracy of non-invasive prenatal testing (NIPT) for Down, Edwards and Patau syndromes using cell-free fetal DNA and identify factors affecting accuracy. DESIGN Systematic review and meta-analysis of published studies. DATA SOURCES PubMed, Ovid Medline, Ovid Embase and the Cochrane Library published from 1997 to 9 February 2015, followed by weekly autoalerts until 1 April 2015. ELIGIBILITY CRITERIA FOR SELECTING STUDIES English language journal articles describing case-control studies with ≥ 15 trisomy cases or cohort studies with ≥ 50 pregnant women who had been given NIPT and a reference standard. RESULTS 41, 37 and 30 studies of 2012 publications retrieved were included in the review for Down, Edwards and Patau syndromes. Quality appraisal identified high risk of bias in included studies, funnel plots showed evidence of publication bias. Pooled sensitivity was 99.3% (95% CI 98.9% to 99.6%) for Down, 97.4% (95.8% to 98.4%) for Edwards, and 97.4% (86.1% to 99.6%) for Patau syndrome. The pooled specificity was 99.9% (99.9% to 100%) for all three trisomies. In 100,000 pregnancies in the general obstetric population we would expect 417, 89 and 40 cases of Downs, Edwards and Patau syndromes to be detected by NIPT, with 94, 154 and 42 false positive results. Sensitivity was lower in twin than singleton pregnancies, reduced by 9% for Down, 28% for Edwards and 22% for Patau syndrome. Pooled sensitivity was also lower in the first trimester of pregnancy, in studies in the general obstetric population, and in cohort studies with consecutive enrolment. CONCLUSIONS NIPT using cell-free fetal DNA has very high sensitivity and specificity for Down syndrome, with slightly lower sensitivity for Edwards and Patau syndrome. However, it is not 100% accurate and should not be used as a final diagnosis for positive cases. TRIAL REGISTRATION NUMBER CRD42014014947.
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Affiliation(s)
| | - Karoline Freeman
- Warwick Medical School, The University of Warwick, Coventry, West Midlands, UK
| | - Julia Geppert
- Warwick Medical School, The University of Warwick, Coventry, West Midlands, UK
| | - Adeola Agbebiyi
- Warwick Medical School, The University of Warwick, Coventry, West Midlands, UK
| | - Olalekan A Uthman
- Warwick Medical School, The University of Warwick, Coventry, West Midlands, UK
| | - Jason Madan
- Warwick Medical School, The University of Warwick, Coventry, West Midlands, UK
| | - Angus Clarke
- Institute of Cancer & Genetics, Cardiff University School of Medicine, Cardiff, UK
| | - Siobhan Quenby
- Warwick Medical School, The University of Warwick, Coventry, West Midlands, UK
| | - Aileen Clarke
- Warwick Medical School, The University of Warwick, Coventry, West Midlands, UK
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319
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Anselem O, Keroui S, Deput-Rampon C, Chartier M, Costa JM, Goffinet F, Tsatsaris V. [Analysis of cell-free DNA in maternal blood for detection of fetal trisomy 21 in high-risk population: Couples acceptance and grounds for refusal]. ACTA ACUST UNITED AC 2016; 45:918-923. [PMID: 26780844 DOI: 10.1016/j.jgyn.2015.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 11/29/2015] [Accepted: 12/21/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To assess the determinants associated with the use of analysis of cell-free DNA in maternal blood for detection of trisomy 21 in high-risk women. MATERIALS AND METHODS Prospective study conducted in a single center between July 15, 2014 and December 15, 2014 on 99 consecutive women with increased risk of trisomy 21 above 1/250. RESULTS Analysis of cell-free DNA in maternal blood for detection of fetal trisomy 21 was proposed to 95 women out of 99, among them, 43 women (45.3%) required the test. Among these 43 women, 17 (38.6%) had a higher socio-economic status versus 10 (19.2%) among the women who did not request the test (P=0.03). The most common reason given by the 52 women who did not request the analysis of cell-free DNA was the cost, for 30 of them (57.7%), then because the test was not providing certainty for the diagnostic of trisomy 21 for 23 women (44.2%). CONCLUSION Analysis of cell-free DNA on maternal blood for detection of trisomy 21 does not seem accepted by the majority of women. The cost is probably the main reason for not using this test, but it seems that the lack of diagnostic certainty is also an obstacle for some women.
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Affiliation(s)
- O Anselem
- Maternité Port-Royal, université Paris Descartes, groupe hospitalier Cochin Broca Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 53, avenue de l'Observatoire, 75014 Paris, France; DHU risques et grossesse, PRES Sorbonne Paris Cité, 53, avenue de l'Observatoire, 75014 Paris, France.
| | - S Keroui
- Maternité Port-Royal, université Paris Descartes, groupe hospitalier Cochin Broca Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 53, avenue de l'Observatoire, 75014 Paris, France; DHU risques et grossesse, PRES Sorbonne Paris Cité, 53, avenue de l'Observatoire, 75014 Paris, France
| | - C Deput-Rampon
- Maternité Port-Royal, université Paris Descartes, groupe hospitalier Cochin Broca Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 53, avenue de l'Observatoire, 75014 Paris, France; DHU risques et grossesse, PRES Sorbonne Paris Cité, 53, avenue de l'Observatoire, 75014 Paris, France
| | - M Chartier
- Maternité Port-Royal, université Paris Descartes, groupe hospitalier Cochin Broca Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 53, avenue de l'Observatoire, 75014 Paris, France; DHU risques et grossesse, PRES Sorbonne Paris Cité, 53, avenue de l'Observatoire, 75014 Paris, France
| | - J-M Costa
- Département de biologie spécialisée et de génétique, laboratoire Cerba, 95310 Saint-Ouen l'Aumône, France
| | - F Goffinet
- Maternité Port-Royal, université Paris Descartes, groupe hospitalier Cochin Broca Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 53, avenue de l'Observatoire, 75014 Paris, France; DHU risques et grossesse, PRES Sorbonne Paris Cité, 53, avenue de l'Observatoire, 75014 Paris, France; Unité Inserm U953, recherche épidémiologique en santé périnatale et santé des femmes et des enfants, UPMC, 53, avenue de l'Observatoire, 75014 Paris, France
| | - V Tsatsaris
- Maternité Port-Royal, université Paris Descartes, groupe hospitalier Cochin Broca Hôtel-Dieu, Assistance publique-Hôpitaux de Paris, 53, avenue de l'Observatoire, 75014 Paris, France; DHU risques et grossesse, PRES Sorbonne Paris Cité, 53, avenue de l'Observatoire, 75014 Paris, France; Unité Inserm U953, recherche épidémiologique en santé périnatale et santé des femmes et des enfants, UPMC, 53, avenue de l'Observatoire, 75014 Paris, France
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320
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Affiliation(s)
- Felix C.K. Wong
- Centre for Research into Circulating Fetal Nucleic Acids, Li Ka Shing Institute of Health Sciences, and
- Department of Chemical Pathology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China; ,
| | - Y.M. Dennis Lo
- Centre for Research into Circulating Fetal Nucleic Acids, Li Ka Shing Institute of Health Sciences, and
- Department of Chemical Pathology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China; ,
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321
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Maxwell S, James I, Dickinson JE, O'Leary P. First trimester screening cut-offs for noninvasive prenatal testing as a contingent screen: Balancing detection and screen-positive rates for trisomy 21. Aust N Z J Obstet Gynaecol 2016; 56:29-35. [PMID: 26749261 DOI: 10.1111/ajo.12428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 11/05/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To provide data on how screen-positive and detection rates of first trimester prenatal screening for fetal Down syndrome vary with changes in the risk cut-off and maternal age to inform contingency criteria for publicly funded noninvasive prenatal testing. MATERIALS AND METHODS First trimester screening and diagnostic data were collected for all women attending for first trimester fetal aneuploidy screening in Western Australia between 2005 and 2009. Prenatal screening and diagnostic data were linked to pregnancy outcomes, including data from the Midwives' Notification System and the Western Australian Registry of Developmental Anomalies. The prevalence of Down syndrome and performance of screening by risk cut-off and/or for women >35 years were analysed. RESULTS The current screening risk cut-off of 1:300 has screen-positive and detection rates of 3.5% and 82%. The screen-positive rate increases by 0.7-0.8% for each 100 point change in risk, up to 19.2% at 1:2500 (96% detection rate). Including all women >35 years as screen positive would increase the screen-positive rate and detection rates to 30.2% and 97.2%. CONCLUSION Variation in screening risk cut-off and the use of maternal age to assess eligibility for noninvasive testing could significantly impact the demand for, and cost of, the test. A contingent first trimester screening approach for risk assessment is superior to the use of a combination of screening and maternal age alone. These data will inform decisions regarding the criteria used to determine eligibility for publicly funded noninvasive prenatal testing.
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Affiliation(s)
- Susannah Maxwell
- Health Policy and Management, School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Ian James
- Institute for Immunology and Infectious Diseases, Murdoch University, Perth, Western Australia, Australia
| | - Jan E Dickinson
- School of Women's and Infants' Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Peter O'Leary
- Health Policy and Management, School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.,School of Women's and Infants' Health, The University of Western Australia, Perth, Western Australia, Australia.,PathWest Laboratory Medicine, Princess Margaret Hospital, Perth, Western Australia, Australia
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322
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Abstract
Cell-free DNA (cfDNA) testing has recently become indispensable in diagnostic testing and screening. In the prenatal setting, this type of testing is often called noninvasive prenatal testing (NIPT). With a number of techniques, using either next-generation sequencing or single nucleotide polymorphism-based approaches, fetal cfDNA in maternal plasma can be analyzed to screen for rhesus D genotype, common chromosomal aneuploidies, and increasingly for testing other conditions, including monogenic disorders. With regard to screening for common aneuploidies, challenges arise when implementing NIPT in current prenatal settings. Depending on the method used (targeted or nontargeted), chromosomal anomalies other than trisomy 21, 18, or 13 can be detected, either of fetal or maternal origin, also referred to as unsolicited or incidental findings. For various biological reasons, there is a small chance of having either a false-positive or false-negative NIPT result, or no result, also referred to as a "no-call." Both pre- and posttest counseling for NIPT should include discussing potential discrepancies. Since NIPT remains a screening test, a positive NIPT result should be confirmed by invasive diagnostic testing (either by chorionic villus biopsy or by amniocentesis). As the scope of NIPT is widening, professional guidelines need to discuss the ethics of what to offer and how to offer. In this review, we discuss the current biochemical, clinical, and ethical challenges of cfDNA testing in the prenatal setting and its future perspectives including novel applications that target RNA instead of DNA.
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323
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Gil MM, Revello R, Poon LC, Akolekar R, Nicolaides KH. Clinical implementation of routine screening for fetal trisomies in the UK NHS: cell-free DNA test contingent on results from first-trimester combined test. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:45-52. [PMID: 26498918 DOI: 10.1002/uog.15783] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Cell-free DNA (cfDNA) analysis of maternal blood for detection of trisomies 21, 18 and 13 is superior to other methods of screening but is expensive. One strategy to maximize performance at reduced cost is to offer cfDNA testing contingent on the results of the first-trimester combined test that is used currently. The objectives of this study were to report the feasibility of implementing such screening, to examine the factors affecting patient decisions concerning their options for screening and decisions on the management of affected pregnancies and to report the prenatal diagnosis of fetal trisomies and outcome of affected pregnancies following the introduction of contingent screening. METHODS We examined routine clinical implementation of contingent screening in 11,692 singleton pregnancies in two National Health Service (NHS) hospitals in the UK. Women with a risk ≥ 1 in 100 (high-risk group) were offered options of invasive testing, cfDNA testing or no further testing, and those with a risk between 1 in 101 and 1 in 2500 (intermediate-risk group) were offered cfDNA testing or no further testing. The trisomic status of the pregnancies was determined by prenatal or postnatal karyotyping or by examination of the neonates. RESULTS In the study population of 11,692 pregnancies, there were 47 cases of trisomy 21 and 28 of trisomies 18 or 13. Screening with the combined test followed by invasive testing for all patients in the high-risk group potentially could have detected 87% of trisomy 21 and 93% of trisomies 18 or 13, at a false-positive rate of 3.4%; the respective values for cfDNA testing in the high- and intermediate-risk groups were 98%, 82% and 0.25%. However, in the high-risk group, 38% of women chose invasive testing and 60% chose cfDNA testing; in the intermediate-risk group 92% opted for cfDNA testing. A prenatal diagnosis was made in 43 (91.5%) pregnancies with trisomy 21 and all pregnancies with trisomies 18 or 13. In many affected pregnancies the parents chose to avoid testing or termination and 32% of pregnancies with trisomy 21 resulted in live births. CONCLUSIONS Screening for fetal trisomies by cfDNA analysis of maternal blood, contingent on the results of the combined test, can be implemented easily in routine clinical practice. In the high-risk group from the combined test, most but not all women chose cfDNA testing rather than invasive testing. Performance of screening for trisomy 21 was superior by the cfDNA test than by the combined test. However, prenatal detection of trisomies and pregnancy outcome depend not only on performance of screening tests but also on parental choice.
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Affiliation(s)
- M M Gil
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - R Revello
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - L C Poon
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - R Akolekar
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
- Department of Fetal Medicine, Medway Maritime Hospital, Gillingham, Kent, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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324
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Abstract
Prenatal diagnosis and screening have undergone rapid development in recent years, with advances in molecular technology driving the change. Noninvasive prenatal testing (NIPT) for Down syndrome as a highly sensitive screening test is now available worldwide through the commercial sector with many countries moving toward implementation into their publically funded maternity systems. Noninvasive prenatal diagnosis (NIPD) can now be performed for definitive diagnosis of some recessive and X-linked conditions, rather than just paternally inherited dominant and de novo conditions. NIPD/T offers pregnant couples greater choice during their pregnancy as these safer methods avoid the risk of miscarriage associated with invasive testing. As the cost of sequencing falls and technology develops further, there may well be potential for whole exome and whole genome sequencing of the unborn fetus using cell-free DNA in the maternal plasma. How such assays can or should be implemented into the clinical setting remain an area of significant debate, but it is clear that the progress made to date for safer prenatal testing has been welcomed by expectant couples and their healthcare professionals.
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325
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Hui L, Tabor A, Walker SP, Kilby MD. How to safeguard competency and training in invasive prenatal diagnosis: 'the elephant in the room'. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:8-13. [PMID: 26643796 DOI: 10.1002/uog.15806] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 10/21/2015] [Accepted: 10/27/2015] [Indexed: 06/05/2023]
Affiliation(s)
- L Hui
- Perinatal Medicine, Mercy Hospital for Women, Heidelberg, VIC, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia
- Public Health Genetics, Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, VIC, Australia
| | - A Tabor
- Center of Fetal Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Faculty of Medicine and Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - S P Walker
- Perinatal Medicine, Mercy Hospital for Women, Heidelberg, VIC, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC, Australia
| | - M D Kilby
- Fetal Medicine Centre, Birmingham Women's Foundation Trust, and University of Birmingham, Birmingham, UK
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326
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Bevilacqua E, Guizani M, Cos Sanchez T, Jani JC. Concerns with performance of screening for aneuploidy by cell-free DNA analysis of maternal blood in twin pregnancy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 47:124-125. [PMID: 26148199 DOI: 10.1002/uog.14938] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 06/30/2015] [Accepted: 06/30/2015] [Indexed: 06/04/2023]
Affiliation(s)
- E Bevilacqua
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M Guizani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - T Cos Sanchez
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - J C Jani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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327
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Wilson RD, Poon LC, Ghidini A. Current controversies in prenatal diagnosis 3: is there still a value in a nuchal translucency screening ultrasound in conjunction with maternal plasma non-invasive cell-free DNA testing? Prenat Diagn 2015; 36:20-4. [DOI: 10.1002/pd.4719] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 10/26/2015] [Accepted: 10/27/2015] [Indexed: 11/09/2022]
Affiliation(s)
- R. Douglas Wilson
- Department of Obstetrics and Gynaecology, Cummings School of Medicine; University of Calgary; Calgary Alberta Canada
| | - Liona C. Poon
- Division of Women's Health; King's College London; London UK
| | - Alessandro Ghidini
- Perinatal Diagnostic Center; Inova Alexandria Hospital; Alexandria VA USA
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328
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Hill M, Johnson JA, Langlois S, Lee H, Winsor S, Dineley B, Horniachek M, Lalatta F, Ronzoni L, Barrett AN, Advani HV, Choolani M, Rabinowitz R, Pajkrt E, van Schendel RV, Henneman L, Rommers W, Bilardo CM, Rendeiro P, Ribeiro MJ, Rocha J, Bay Lund IC, Petersen OB, Becher N, Vogel I, Stefánsdottir V, Ingvarsdottir S, Gottfredsdottir H, Morris S, Chitty LS. Preferences for prenatal tests for Down syndrome: an international comparison of the views of pregnant women and health professionals. Eur J Hum Genet 2015; 24:968-75. [PMID: 26577044 DOI: 10.1038/ejhg.2015.249] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 09/06/2015] [Accepted: 10/23/2015] [Indexed: 12/12/2022] Open
Abstract
Non-invasive prenatal testing is increasingly available worldwide and stakeholder viewpoints are essential to guide implementation. Here we compare the preferences of women and health professionals from nine different countries towards attributes of non-invasive and invasive prenatal tests for Down syndrome. A discrete choice experiment was used to obtain participants' stated preference for prenatal tests that varied according to four attributes: accuracy, time of test, risk of miscarriage, and type of information. Pregnant women and health professionals were recruited from Canada, Denmark, Iceland, Israel, Italy, the Netherlands, Portugal, Singapore, and the United Kingdom. A total of 2666 women's and 1245 health professionals' questionnaires were included in the analysis. Differences in preferences were seen between women and health professionals within and between countries. Overall, women placed greater emphasis on test safety and comprehensive information than health professionals, who emphasised accuracy and early testing. Differences between women's and health professionals' preferences are marked between countries. Varied approaches to implementation and service delivery are therefore needed and individual countries should develop guidelines appropriate for their own social and screening contexts.
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Affiliation(s)
- Melissa Hill
- Genetics and Genomic Medicine, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jo-Ann Johnson
- Department of Obstetrics & Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Sylvie Langlois
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hyun Lee
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephanie Winsor
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Brigid Dineley
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Marisa Horniachek
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Faustina Lalatta
- Clinical Genetics Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Luisa Ronzoni
- Clinical Genetics Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Angela N Barrett
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Henna V Advani
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mahesh Choolani
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ron Rabinowitz
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Centre, Jerusalem, Israel
| | - Eva Pajkrt
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Rachèl V van Schendel
- Department of Clinical Genetics, Section of Community Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Lidewij Henneman
- Department of Clinical Genetics, Section of Community Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Wieke Rommers
- Department of Obstetrics and Gynecology, Fetal Medicine Unit, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Caterina M Bilardo
- Department of Obstetrics and Gynecology, Fetal Medicine Unit, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | | | | | - José Rocha
- CGC Genetics, Porto, Portugal.,IINFACTS, CESPU, Porto, Portugal
| | | | - Olav B Petersen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Naja Becher
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Ida Vogel
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Vigdis Stefánsdottir
- Department of Genetics and Molecular Medicine, Landspitali University Hospital, Reykjavik, Iceland
| | - Sigrun Ingvarsdottir
- Landspitali, National University Hospital, Reykjavik, Iceland.,Department of Midwifery, Faculty of Nursing, University of Iceland, Reykjavik, Iceland
| | - Helga Gottfredsdottir
- Landspitali, National University Hospital, Reykjavik, Iceland.,Department of Midwifery, Faculty of Nursing, University of Iceland, Reykjavik, Iceland
| | - Stephen Morris
- Research Department of Applied Health Research, University College London, London, UK
| | - Lyn S Chitty
- Genetics and Genomic Medicine, UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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329
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Jani J, Rego de Sousa MJ, Benachi A. Cell-free DNA testing: how to choose which laboratory to use? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:515-517. [PMID: 26300279 DOI: 10.1002/uog.15733] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 08/14/2015] [Accepted: 08/19/2015] [Indexed: 06/04/2023]
Affiliation(s)
- J Jani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M-J Rego de Sousa
- Immunology, Autoimmunity and Pre-Natal Unit, Clinical Pathology Department, Centro de Medicina Laboratorial Germano de Sousa, Lisbon, Portugal
| | - A Benachi
- Department of Obstetrics, Gynecology and Reproductive Medicine and Centre Maladies Rares: Hernie de Coupole Diaphragmatique, Hôpital Antoine Béclère, APHP, Université Paris Sud, Clamart, France
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330
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Tamminga S, van Schendel RV, Rommers W, Bilardo CM, Pajkrt E, Dondorp WJ, van Maarle M, Cornel MC, Henneman L. Changing to NIPT as a first-tier screening test and future perspectives: opinions of health professionals. Prenat Diagn 2015; 35:1316-23. [PMID: 26411372 DOI: 10.1002/pd.4697] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/04/2015] [Accepted: 09/20/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of this study was to investigate health professionals' opinions toward offering noninvasive prenatal testing (NIPT) as first-tier screening test regardless of pregnant women's risk, and toward a potential broader range of disorders. METHODS A questionnaire completed by obstetric health professionals (n = 240) after an in-service NIPT training in the West and North of the Netherlands. RESULTS The majority (72%) of respondents favored replacing first-trimester combined test (FCT) by NIPT, although 43% preferred to maintain nuchal translucency measurement. Many respondents believed that replacing FCT by NIPT would only have advantages (57%), would lead to more pregnant women opting for prenatal testing (69%), and would simplify counseling (47%). Differences in attitudes toward counseling between health professionals were observed. When considering NIPT to screen for broader range of disorders, the majority (92%) thought that this should include disorders characterized by neonatal death, whereas 52% of the respondents favored testing for fetomaternal risk factors. Overall, 46% thought screening should be offered as a fixed list of disorders. CONCLUSION Most health professionals favor NIPT instead of FCT but prefer to maintain nuchal translucency measurement. If NIPT becomes available as a first-tier screening test, attention remains necessary to ensure that pregnant women make well-informed decisions in line with the aim of prenatal screening.
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Affiliation(s)
- Saskia Tamminga
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, the Netherlands
| | - Rachèl V van Schendel
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, the Netherlands.,EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Wieke Rommers
- Department of Fetal Medicine and Prenatal Diagnosis, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Caterina M Bilardo
- Department of Fetal Medicine and Prenatal Diagnosis, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Eva Pajkrt
- Department of Obstetrics and Gynecology, Fetal Medicine Unit, Academic Medical Center, Amsterdam, the Netherlands
| | - Wybo J Dondorp
- Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences, Research Institutes GROW and CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Merel van Maarle
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, the Netherlands
| | - Martina C Cornel
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, the Netherlands.,EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Lidewij Henneman
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, the Netherlands.,EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
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331
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Stokowski R, Wang E, White K, Batey A, Jacobsson B, Brar H, Balanarasimha M, Hollemon D, Sparks A, Nicolaides K, Musci TJ. Clinical performance of non-invasive prenatal testing (NIPT) using targeted cell-free DNA analysis in maternal plasma with microarrays or next generation sequencing (NGS) is consistent across multiple controlled clinical studies. Prenat Diagn 2015; 35:1243-6. [PMID: 26332378 PMCID: PMC5057317 DOI: 10.1002/pd.4686] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 08/14/2015] [Accepted: 08/27/2015] [Indexed: 12/14/2022]
Abstract
Objective To evaluate the clinical performance of non‐invasive prenatal testing for trisomy 21, 18, and 13 using targeted cell‐free DNA (cfDNA) analysis. Methods Targeted cfDNA analysis using DANSR™ and FORTE™ with microarray quantitation was used to evaluate the risk of trisomy 21, 18, and 13 in blinded samples from 799 singleton, twin, natural, and IVF pregnancies. Subjects either had fetal chromosome evaluation by karyotype, FISH, QF‐PCR, or karyotype for newborns with suspected aneuploidy at birth. The results of targeted cfDNA analysis were compared to clinical genetic testing outcomes to assess clinical performance. Results Targeted cfDNA analysis with microarray quantification identified 107/108 trisomy 21 cases (99.1%), 29/30 trisomy 18 cases (96.7%), and 12/12 trisomy 13 cases (100%). The specificity was 100% for all three trisomies. Combining this data with all published clinical performance studies using DANSR/FORTE methodology for greater than 23 000 pregnancies, the sensitivity of targeted cfDNA analysis was calculated to be greater than 99% for trisomy 21, 97% for trisomy 18, and 94% for trisomy 13. Specificity for each trisomy was greater than 99.9%. Conclusion Targeted cfDNA analysis demonstrates consistently high sensitivity and extremely low false positive rates for common autosomal trisomies in pregnancy across quantitation platforms. © 2015 Ariosa Diagnostics Inc. Prenatal Diagnosis published by John Wiley & Sons, Ltd. What's already known about this topic?NIPT using targeted cfDNA analysis with NGS has high sensitivity and specificity for fetal trisomy 21 and other autosomal trisomies.
What does this study add?This study establishes the high sensitivity and specificity of NIPT using targeted cfDNA analysis with a microarray quantitation platform, and demonstrates that clinical performance is based on the targeted cfDNA analysis method rather than the quantitation method, as the performance using microarray is comparable with performance from previous NGS studies.
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Affiliation(s)
| | - Eric Wang
- Ariosa Diagnostics, Inc., San Jose, CA, USA
| | | | | | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Herb Brar
- Prenatal Diagnostic and Perinatal Center, Riverside, CA, USA
| | | | | | | | - Kypros Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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332
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Prenatal aneuploidy screening using cell free DNA. Am J Obstet Gynecol 2015; 213:596-7. [PMID: 26071919 DOI: 10.1016/j.ajog.2015.06.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 06/08/2015] [Indexed: 11/22/2022]
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333
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Minear MA, Lewis C, Pradhan S, Chandrasekharan S. Global perspectives on clinical adoption of NIPT. Prenat Diagn 2015; 35:959-67. [PMID: 26085345 DOI: 10.1002/pd.4637] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 05/22/2015] [Accepted: 06/10/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The goals of this study were to assess global trends in clinical implementation of noninvasive prenatal testing (NIPT), as commercial tests are marketed increasingly worldwide, and to identify potential challenges for current or future use. METHODS We surveyed clinicians from 46 countries about the availability of NIPT, their experiences with using NIPT, and their views on clinical, ethical, and legal issues affecting implementation in their countries. RESULTS Forty-nine respondents from 28 countries completed the survey. The majority reported that NIPT is available in their country (n = 43) and that they offer NIPT in their current practice (n = 38). Eighteen respondents from 14 countries reported that there are plans to introduce NIPT into routine prenatal care in their country. Test prices varied widely, ranging from $350 to $2900, and several respondents observed that high test prices limited or restricted widespread use of NIPT. Responses varied both across and within countries regarding who is offered NIPT and what the overall screening protocol should be. CONCLUSION This study provides a snapshot of current use and experiences with NIPT globally. It also highlights differences in service provision that exists both across and within countries, emphasizing the need for developing national and international implementation guidelines for NIPT.
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Affiliation(s)
| | - Celine Lewis
- Genomic and Genetic Medicine, UCL Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Subarna Pradhan
- Duke Global Health Institute, Duke University, Durham, NC, USA
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334
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Dash P, Puri RD, Goyal M, Bijarnia S, Lall M, Kotecha U, Verma IC. Absent/Hypoplastic Fetal Nasal Bone and Its Association with Aneuploidies. JOURNAL OF FETAL MEDICINE 2015. [DOI: 10.1007/s40556-015-0051-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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335
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Grati FR, Bajaj K, Malvestiti F, Agrati C, Grimi B, Malvestiti B, Pompilii E, Maggi F, Gross S, Simoni G, Ferreira JCP. The type of feto-placental aneuploidy detected by cfDNA testing may influence the choice of confirmatory diagnostic procedure. Prenat Diagn 2015. [PMID: 26211640 DOI: 10.1002/pd.4659] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Cell-free DNA (cfDNA) screening can provide false positive/negative results because the fetal fraction originates primarily from trophoblast. Consequently, invasive diagnostic testing is recommended to confirm a high-risk result. Currently, there is debate about the most appropriate invasive method. We sought to estimate the frequency in which a chorionic villus sampling (CVS) performed after a high-risk cfDNA result would require a follow-up amniocentesis due to placental mosaicism. METHODS Analyses of the frequencies of the different types of mosaicism involving cytotrophoblasts, for trisomies 21 (T21), 18 (T18), 13 (T13) and monosomy X (MX) among 52,673 CVS karyotypes obtained from cytotrophoblast, mesenchyme and confirmatory amniocentesis. RESULTS After a high-risk cfDNA result for T21, 18, 13 and MX, the likelihood of finding CVS mosaicism and need for amniocentesis is, respectively, 2%, 4%, 22% and 59%. When mosaicism is detected by CVS, the likelihood of fetal confirmation by amniocentesis is, respectively, 44%, 14%, 4% and 26%. CONCLUSIONS In cases of high-risk cfDNA results for T21/T18, CVS (combining cytotrophoblast and mesenchyme analysis) can be considered, but with the caveat of 2-4% risk of an inconclusive result requiring further testing. In high-risk results for MX/T13, amniocentesis would appear to be the most appropriate follow-up diagnostic test, especially in the absence of sonographic findings.
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Affiliation(s)
| | - Komal Bajaj
- Department of Obstetrics, Gynecology and Women's Health at Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Cristina Agrati
- Toma Advanced Biomedical Assays, Busto Arsizio, Varese, Italy
| | - Beatrice Grimi
- Toma Advanced Biomedical Assays, Busto Arsizio, Varese, Italy
| | | | - Eva Pompilii
- Toma Advanced Biomedical Assays, Busto Arsizio, Varese, Italy
| | - Federico Maggi
- Toma Advanced Biomedical Assays, Busto Arsizio, Varese, Italy
| | - Susan Gross
- Department of Obstetrics, Gynecology and Women's Health at Albert Einstein College of Medicine, Bronx, NY, USA.,Natera, San Carlos, CA, USA
| | - Giuseppe Simoni
- Toma Advanced Biomedical Assays, Busto Arsizio, Varese, Italy
| | - Jose Carlos P Ferreira
- Department of Obstetrics, Gynecology and Women's Health at Albert Einstein College of Medicine, Bronx, NY, USA.,1st Department of Obstetrics and Gynecology, Medical University of Warsaw, 02-015, Warsaw, Poland
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336
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337
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Non-invasive Prenatal Screening for Fetal Aneuploidy: Comparison with Cytogenetic Results. CURRENT GENETIC MEDICINE REPORTS 2015. [DOI: 10.1007/s40142-015-0072-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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338
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Minear MA, Alessi S, Allyse M, Michie M, Chandrasekharan S. Noninvasive Prenatal Genetic Testing: Current and Emerging Ethical, Legal, and Social Issues. Annu Rev Genomics Hum Genet 2015; 16:369-98. [DOI: 10.1146/annurev-genom-090314-050000] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Mollie A. Minear
- Duke Science & Society, Duke University, Durham, North Carolina 27708
| | - Stephanie Alessi
- Stanford Center for Biomedical Ethics, Stanford University, Stanford, California 94305
| | - Megan Allyse
- Biomedical Ethics Program, Mayo Clinic, Rochester, Minnesota 55905
| | - Marsha Michie
- Institute for Health and Aging, University of California, San Francisco, California 94143
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339
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Maxwell S, Dickinson JE, Murch A, O'Leary P. The potential impact of NIPT as a second-tier screen on the outcomes of high-risk pregnancies with rare chromosomal abnormalities. Aust N Z J Obstet Gynaecol 2015; 55:420-6. [DOI: 10.1111/ajo.12385] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 06/24/2015] [Indexed: 02/04/2023]
Affiliation(s)
- Susannah Maxwell
- Health Policy and Management; School of Public Health; Faculty of Health Sciences; Curtin University; Perth Western Australia Australia
| | - Jan E. Dickinson
- Ultrasound Department; King Edward Memorial Hospital; Perth Western Australia Australia
- School of Women's and Infants' Health; The University of Western Australia; Perth Western Australia Australia
| | - Ashleigh Murch
- PathWest Laboratory Medicine; QEII Medical Centre; Perth Western Australia Australia
- School of Pathology and Laboratory Medicine; The University of Western Australia; Perth Western Australia Australia
| | - Peter O'Leary
- Health Policy and Management; School of Public Health; Faculty of Health Sciences; Curtin University; Perth Western Australia Australia
- School of Women's and Infants' Health; The University of Western Australia; Perth Western Australia Australia
- PathWest Laboratory Medicine; Princess Margaret Hospital for Children; Perth Western Australia Australia
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340
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Mersy E, de Die-Smulders CEM, Coumans ABC, Smits LJM, de Wert GMWR, Frints SGM, Veltman JA. Advantages and Disadvantages of Different Implementation Strategies of Non-Invasive Prenatal Testing in Down Syndrome Screening Programmes. Public Health Genomics 2015. [PMID: 26202817 DOI: 10.1159/000435780] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Implementation of non-invasive prenatal testing (NIPT) in Down syndrome screening programmes requires health policy decisions about its combination with other tests and its timing in pregnancy. AIM Our aim was to aid health policy decision makers by conducting a quantitative analysis of different NIPT implementation strategies. METHODS Decision trees were created to illustrate all plausible alternatives in a theoretical cohort of 100,000 pregnant women in five screening programmes: classical screening by the first-trimester combined test (FCT), pre-selection of high-risk women prior to NIPT by the FCT, NIPT as the first screening test at 10 weeks and at 13 weeks, and the simultaneous conductance of NIPT and the FCT. RESULTS Pre-selection by FCT prior to NIPT reduces the number of amniocenteses to a minimum because of a reduction of false-positive NIPT results. If NIPT is the first screening test, it detects almost all fetal Down syndrome cases. NIPT at 10 weeks reassures women early in pregnancy, while NIPT at 13 weeks prevents unnecessary tests due to spontaneous miscarriages and allows for immediate confirmation by amniocentesis. CONCLUSION Every implementation strategy has its advantages and disadvantages. The most favourable implementation strategy may be NIPT as the first screening test at 13 weeks, offering the most accurate screening test for Down syndrome, when the risk for spontaneous miscarriage has declined remarkably and timely confirmation by amniocentesis can be performed.
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Affiliation(s)
- Elke Mersy
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands
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341
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Dickinson JE, Costa CM. Non‐invasive prenatal testing: the new era in reproductive medicine. Med J Aust 2015; 203:57-8. [DOI: 10.5694/mja15.00299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 03/27/2015] [Indexed: 11/17/2022]
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342
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Affiliation(s)
- Roberto Romero
- Perinatology Research Branch, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, Maryland, and Detroit, Michigan
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan
| | - Maurice J. Mahoney
- Departments of Genetics, Pediatrics, and Obstetrics & Gynecology, Yale University School of Medicine, New Haven, Connecticut
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343
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Genomics-based non-invasive prenatal testing for detection of fetal chromosomal aneuploidy in pregnant women. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011767] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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344
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Kagan KO, Sonek J, Berg X, Berg C, Mallmann M, Abele H, Hoopmann M, Geipel A. Facial markers in second- and third-trimester fetuses with trisomy 18 or 13, triploidy or Turner syndrome. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:60-65. [PMID: 25175793 DOI: 10.1002/uog.14655] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 07/22/2014] [Accepted: 07/25/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To examine the effectiveness of nasal bone (NB) evaluation (including NB length (NBL)), prenasal thickness (PT) measurement, the PT:NBL ratio and the prefrontal space ratio (PFSR) in the identification of fetuses with trisomy 18 or 13, triploidy or Turner syndrome. METHODS This was a retrospective study using stored midsagittal two-dimensional images of the facial profile of fetuses with trisomy 18 or 13, triploidy or Turner syndrome in the second and third trimesters. For images of acceptable quality, measurements were obtained of NBL (where NB was present), PT, the PT:NBL ratio and PFSR, and these measurements were compared with previously published normal ranges. RESULTS The search of databases identified 189 fetuses that met the study criteria: 132 (69.8%) with trisomy 18, 40 (21.2%) with trisomy 13, 10 (5.3%) with triploidy and seven (3.7%) with Turner syndrome. The NB was either absent or its measurement was below the 5(th) centile in 67 (50.8%), 20 (50.0%), five (50.0%) and two (28.6%) of the fetuses with trisomy 18, trisomy 13, triploidy and Turner syndrome, respectively. The PT measurement was above the 95(th) centile in 24 (18.2%), six (15.0%), one (10.0%) and one (14.3%) of the affected fetuses, respectively. The PFSR was abnormal in 72 (54.5%), 29 (72.5%), seven (70%) and four (57.1%) of the cases and the PT:NBL ratio was above the 95(th) centile or the nasal bone was absent in 72 (54.5%), 20 (50.0%), six (60.0%) and four (57.1%) cases, respectively. CONCLUSION Although each of the facial markers considered provides some useful information in screening for trisomy 18, trisomy 13, triploidy and Turner syndrome, the performance of none of the markers appears to be as good as that in screening for trisomy 21.
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Affiliation(s)
- K O Kagan
- Department of Obstetrics and Gynaecology, University of Tübingen, Tübingen, Germany
| | - J Sonek
- Fetal Medicine Foundation USA, Dayton, OH, USA
- Division of Maternal Fetal Medicine, Wright State University, Dayton, OH, USA
| | - X Berg
- Department of Obstetrics and Gynaecology, University of Tübingen, Tübingen, Germany
| | - C Berg
- Department of Obstetrics and Gynaecology, University of Bonn, Bonn, Germany
- Department of Obstetrics and Gynaecology, University of Cologne, Cologne, Germany
| | - M Mallmann
- Department of Obstetrics and Gynaecology, University of Bonn, Bonn, Germany
| | - H Abele
- Department of Obstetrics and Gynaecology, University of Tübingen, Tübingen, Germany
| | - M Hoopmann
- Department of Obstetrics and Gynaecology, University of Tübingen, Tübingen, Germany
| | - A Geipel
- Department of Obstetrics and Gynaecology, University of Bonn, Bonn, Germany
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345
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Hui L, Muggli EE, Halliday JL. Population-based trends in prenatal screening and diagnosis for aneuploidy: a retrospective analysis of 38 years of state-wide data. BJOG 2015; 123:90-7. [PMID: 26108969 DOI: 10.1111/1471-0528.13488] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To analyse population-based trends over the entire history of prenatal testing for aneuploidy. DESIGN Retrospective analysis of state-wide data sets. SETTING Australian state of Victoria with ~70 000 annual births. POPULATION All pregnant women undergoing invasive prenatal testing at <25 weeks' gestation from 1976 to 2013. METHODS Analysis of three state-wide data sets: (1) Prenatal diagnosis data set of 119 404 amniocenteses and chorionic villus samplings from 1976 to 2013; (2) central serum screening laboratory data set from 1996 to 2013; (3) government birth statistics from 1976 to 2013. MAIN OUTCOME MEASURES Annual numbers and uptake rates of invasive prenatal tests and serum screening, indications for invasive prenatal testing, prenatal diagnoses of aneuploidy, diagnostic yield of invasive tests. RESULTS Annual numbers of invasive prenatal tests climbed steadily from 1976, then declined from 2000. In 2013, the number of invasive prenatal tests was the lowest in 25 years, while the number of trisomy 21 diagnoses was the highest ever recorded. Annual uptake of serum screening climbed from 1.6 to 83% over 1996-2013. Results from 2013 showed a high diagnostic yield (15.8%) for a low rate of invasive testing (3.4% of births). Over four decades, the number of invasive procedures performed for each diagnosis of major chromosome abnormality declined from 100 to six. CONCLUSIONS This study demonstrates historic reductions in the proportion of women undergoing invasive testing and dramatic improvements in diagnostic yield. Monitoring the impact of new prenatal technologies on this progress remains an important research priority. TWEETABLE ABSTRACT Invasive prenatal testing has reached historic lows due to dramatic improvements in Down syndrome screening.
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Affiliation(s)
- L Hui
- Public Health Genetics, Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Vic., Australia.,Department of Perinatal Medicine, The Mercy Hospital for Women, Heidelberg, Vic., Australia
| | - E E Muggli
- Public Health Genetics, Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Vic., Australia.,Department of Paediatrics, University of Melbourne, Parkville, Vic., Australia
| | - J L Halliday
- Public Health Genetics, Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Vic., Australia.,Department of Paediatrics, University of Melbourne, Parkville, Vic., Australia
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346
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Wagner P, Sonek J, Hoopmann M, Abele H, Brucker S, Kagan KO. Increased Umbilical Artery Pulsatility Index in Third-Trimester Fetuses with Trisomy 21. Fetal Diagn Ther 2015; 39:100-4. [DOI: 10.1159/000433431] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Objective: To examine the umbilical arterial Doppler flow patterns in late third-trimester fetuses with trisomy 21. Methods: This is a retrospective study on fetuses with trisomy 21 that were evaluated after 33 weeks' gestation at the Department of Obstetrics and Gynaecology of the University of Tuebingen, Germany. The umbilical and the middle cerebral artery (UA and ACM) pulsatility index (PI) measurements and the abdominal circumference were transformed into z-values. Results: Forty-two fetuses met the study criteria. The mean gestational age at the time of the first and the second visit was 35.0 and 36.6 weeks, respectively. The mean UA PI was 1.31 and 1.38, which corresponds to z-values of 2.20 and 2.70. In 24 (57.1%) cases, both PI measurements were above the 95th centile. A linear regression analysis demonstrated that the mean of both UA PI was not dependent on the abdominal circumference or on any other examined maternal and pregnancy characteristics. The mean ACM PI at the first and the second visit was 1.62 and 1.48, respectively, corresponding to mean z-values of -0.59 and -0.75, and in none of the cases was it below the 5th centile. Conclusion: In half of the third-trimester fetuses with trisomy 21, the resistance in the UA is increased - even in the absence of placental insufficiency.
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#36: Prenatal aneuploidy screening using cell-free DNA. Am J Obstet Gynecol 2015; 212:711-6. [PMID: 25813012 DOI: 10.1016/j.ajog.2015.03.043] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 03/20/2015] [Indexed: 02/05/2023]
Abstract
Recent advances in technology have created exciting opportunities to expand and improve genetic testing options that are available to women during pregnancy. However, the novelty and complexity of these technologies, combined with the commercial interest to implement these tests rapidly into routine clinical care, have created challenges for physicians and patients and potentially will lead to misunderstanding, misuse, and unintended consequences. The purpose of this document was to aid clinicians in their day-to-day practice of counseling patients regarding prenatal aneuploidy testing options with cell-free DNA screening, which includes how it compares to current testing methods, potential benefits and harms, and its limitations and caveats.
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Palomaki GE, Eklund EE, Neveux LM, Lambert Messerlian GM. Evaluating first trimester maternal serum screening combinations for Down syndrome suitable for use with reflexive secondary screening via sequencing of cell free DNA: high detection with low rates of invasive procedures. Prenat Diagn 2015; 35:789-96. [PMID: 25967109 DOI: 10.1002/pd.4609] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 04/22/2015] [Accepted: 04/24/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Examine primary Down syndrome screening using combinations of first trimester serum markers, with and without sequencing of cell free DNA as a secondary reflexive test. METHODS Samples from 40 Down syndrome cases were matched with five control samples and tested for PAPP-A, free β, AFP, inhibin-A and PlGF. Results were converted to weight-adjusted multiples of the median (MoM) and population parameters computed. Monte Carlo simulation modeled Down syndrome detection and false positive rates for various marker combinations. After reflexive DNA testing, the revised detection and false positive rates were also computed. RESULTS At a primary false positive rate of 20%, the baseline combination (maternal age, PAPP-A and free β) detected 86.9%. Adding AFP or PlGF increased detection to 89.8% and 89.5%, respectively. Adding AFP and PlGF, AFP and inhibin-A, or all three markers, detected 93.7%, 94.1% and 95.5%, respectively. Modeling reflexive cf DNA testing results in little loss in detection (1%), but false positive rates fall to 0.2%. CONCLUSION First trimester reflexive testing does not require nuchal translucency measurements, and has high detection and very low rates of invasive procedures. However, timing of DNA sample collection and the costs of sample collection and DNA testing need to be considered before implementation.
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Affiliation(s)
- Glenn E Palomaki
- Division of Medical Screening and Special Testing, Department of Pathology and Laboratory Medicine, Women and Infants Hospital, Providence, RI, USA.,Department of Pathology and Laboratory Medicine, Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Elizabeth E Eklund
- Division of Medical Screening and Special Testing, Department of Pathology and Laboratory Medicine, Women and Infants Hospital, Providence, RI, USA
| | - Louis M Neveux
- Division of Medical Screening and Special Testing, Department of Pathology and Laboratory Medicine, Women and Infants Hospital, Providence, RI, USA
| | - Geralyn M Lambert Messerlian
- Division of Medical Screening and Special Testing, Department of Pathology and Laboratory Medicine, Women and Infants Hospital, Providence, RI, USA.,Department of Pathology and Laboratory Medicine, Alpert School of Medicine, Brown University, Providence, RI, USA
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Wou K, Feinberg JL, Wapner RJ, Simpson JL. Cell-free DNA versus intact fetal cells for prenatal genetic diagnostics: what does the future hold? Expert Rev Mol Diagn 2015; 15:989-98. [DOI: 10.1586/14737159.2015.1051529] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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