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Park JE, Kang KM, Kim H, Jang HY, Go M, Yang SH, Jeong D, Jeong H, Kim JC, Lim SY, Cha DH, Shim SH. Cell-Free Fetal DNA Screening Analysis in Korean Pregnant Women: Six Years of Experience and a Retrospective Study of 9327 Patients Analyzed from 2017 to 2022. J Pers Med 2023; 13:1468. [PMID: 37888079 PMCID: PMC10608624 DOI: 10.3390/jpm13101468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/22/2023] [Accepted: 09/27/2023] [Indexed: 10/28/2023] Open
Abstract
Cell-free DNA (cfDNA) screening for normal fetal aneuploidy has been widely adopted worldwide due to its convenience, non-invasiveness, and high positive predictive rate. We retrospectively evaluated 9327 Korean women with single pregnancies who underwent a non-invasive prenatal test (NIPT) to investigate how various factors such as maternal weight, age, and the method of conception affect the fetal fraction (FF). The average FF was 9.15 ± 3.31%, which decreased significantly as the maternal body mass index (BMI) increased (p < 0.001). The highly obese group showed a 'no-call' rate of 8.01%, which is higher than that of the normal weight group (0.33%). The FF was 8.74 ± 3.20% when mothers were in their 40s, and lower than that when in their 30s (9.23 ± 3.34, p < 0.001) and in the natural pregnancy group (9.31% ± 3.33). The FF of male fetuses was observed to be approximately 2.76% higher on average than that of female fetuses. As the gestational age increased, there was no significant increase in the fraction of fetuses up to 21 weeks compared to that at 10-12 weeks, and a significant increase was observed in the case of 21 weeks or more. The FFs in the NIPT high-risk result group compared to that in the low-risk group were not significantly different (p = 0.62). In conclusion, BMI was the factor most associated with the fetal fraction. Although the NIPT is a highly prevalent method in prenatal analysis, factors affecting the fetal fraction should be thoroughly analyzed to obtain more accurate results.
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Affiliation(s)
- Ji Eun Park
- Center for Genome Diagnostics, CHA Biotech Inc., Seoul 06125, Republic of Korea; (J.E.P.); (K.M.K.); (H.K.); (H.Y.J.); (M.G.); (S.H.Y.); (J.C.K.)
| | - Kyung Min Kang
- Center for Genome Diagnostics, CHA Biotech Inc., Seoul 06125, Republic of Korea; (J.E.P.); (K.M.K.); (H.K.); (H.Y.J.); (M.G.); (S.H.Y.); (J.C.K.)
| | - Hyunjin Kim
- Center for Genome Diagnostics, CHA Biotech Inc., Seoul 06125, Republic of Korea; (J.E.P.); (K.M.K.); (H.K.); (H.Y.J.); (M.G.); (S.H.Y.); (J.C.K.)
| | - Hee Yeon Jang
- Center for Genome Diagnostics, CHA Biotech Inc., Seoul 06125, Republic of Korea; (J.E.P.); (K.M.K.); (H.K.); (H.Y.J.); (M.G.); (S.H.Y.); (J.C.K.)
| | - Minyeon Go
- Center for Genome Diagnostics, CHA Biotech Inc., Seoul 06125, Republic of Korea; (J.E.P.); (K.M.K.); (H.K.); (H.Y.J.); (M.G.); (S.H.Y.); (J.C.K.)
| | - So Hyun Yang
- Center for Genome Diagnostics, CHA Biotech Inc., Seoul 06125, Republic of Korea; (J.E.P.); (K.M.K.); (H.K.); (H.Y.J.); (M.G.); (S.H.Y.); (J.C.K.)
| | - Daeun Jeong
- Department of Biomedical Science, College of Life Science, CHA University, Seongnam 13488, Republic of Korea; (D.J.); (H.J.); (S.Y.L.)
| | - Hyeonmin Jeong
- Department of Biomedical Science, College of Life Science, CHA University, Seongnam 13488, Republic of Korea; (D.J.); (H.J.); (S.Y.L.)
| | - Jong Chul Kim
- Center for Genome Diagnostics, CHA Biotech Inc., Seoul 06125, Republic of Korea; (J.E.P.); (K.M.K.); (H.K.); (H.Y.J.); (M.G.); (S.H.Y.); (J.C.K.)
| | - Seo Young Lim
- Department of Biomedical Science, College of Life Science, CHA University, Seongnam 13488, Republic of Korea; (D.J.); (H.J.); (S.Y.L.)
| | - Dong Hyun Cha
- Center for Genome Diagnostics, CHA Biotech Inc., Seoul 06125, Republic of Korea; (J.E.P.); (K.M.K.); (H.K.); (H.Y.J.); (M.G.); (S.H.Y.); (J.C.K.)
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul 06125, Republic of Korea
| | - Sung Han Shim
- Center for Genome Diagnostics, CHA Biotech Inc., Seoul 06125, Republic of Korea; (J.E.P.); (K.M.K.); (H.K.); (H.Y.J.); (M.G.); (S.H.Y.); (J.C.K.)
- Department of Biomedical Science, College of Life Science, CHA University, Seongnam 13488, Republic of Korea; (D.J.); (H.J.); (S.Y.L.)
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2
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Scott F, Smet ME, Elhindi J, Mogra R, Sunderland L, Ferreira A, Menezes M, Meagher S, McLennan A. Late first-trimester ultrasound findings can alter management after high-risk NIPT result. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:497-503. [PMID: 37247395 DOI: 10.1002/uog.26272] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/14/2023] [Accepted: 05/17/2023] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To evaluate the impact of detailed late first-trimester ultrasound (LFTU) on the positive predictive value (PPV) of a high-risk non-invasive prenatal test (NIPT) result for various chromosomal abnormalities. METHODS This was a retrospective study of all cases undergoing invasive prenatal testing from three tertiary providers of obstetric ultrasound over 4 years, each using NIPT as a first-line screening test. Data were collected from pre-NIPT ultrasound, NIPT, LFTU, placental serology and later ultrasound examinations. Prenatal testing for chromosomal abnormalities was performed by microarray, initially using array comparative genomic hybridization and then single nucleotide polymorphism (SNP) array for the last 2 years. Uniparental disomy testing was performed by SNP array during all 4 years. The majority of NIPT tests were analyzed using the Illumina platform, initially confined to the assessment of the common autosomal trisomies, sex chromosome aneuploidies and rare autosomal trisomies (RAT), then extending to genome-wide analysis for the last 2 years. RESULTS Amniocentesis or chorionic villus sampling (CVS) was performed on 2657 patients, 1352 (51%) of whom had undergone prior NIPT, with 612 (45%) of these returning a high-risk result and meeting the inclusion criteria for the study. LFTU findings significantly affected the PPV of the NIPT result for trisomies 13 (T13), 18 (T18) and 21 (T21), monosomy X (MX) and RAT but not for the other sex chromosomal abnormalities or segmental imbalances (> 7 Mb). Abnormal LFTU increased the PPV close to 100% for T13, T18, T21, MX and RAT. The magnitude of the change in PPV was highest for the most severe chromosomal abnormalities. When LFTU was normal, the incidence of confined placental mosaicism (CPM) was highest in those with a high-risk NIPT result for T13, followed by T18 and T21. After normal LFTU, the PPV for T21, T18, T13 and MX decreased to 68%, 57%, 5% and 25%, respectively. CONCLUSIONS LFTU after a high-risk NIPT result can alter the PPV for many chromosomal abnormalities, assisting counseling regarding invasive prenatal testing and pregnancy management. The high PPVs of NIPT for T21 and T18 are not sufficiently modified by normal LFTU findings to alter management. These at-risk patients should be offered CVS for earlier diagnosis, particularly given the low rate of CPM associated with these aneuploidies. Patients with a high-risk NIPT result for T13 and normal LFTU findings often wait for amniocentesis or avoid invasive testing altogether given the low PPV and higher rate of CPM in this context. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- F Scott
- Sydney Ultrasound for Women, Sydney, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - M-E Smet
- Sydney Ultrasound for Women, Sydney, Australia
- Maternal-Fetal Medicine Department, Westmead Hospital, Sydney, Australia
| | - J Elhindi
- Maternal-Fetal Medicine Department, Westmead Hospital, Sydney, Australia
| | - R Mogra
- Sydney Ultrasound for Women, Sydney, Australia
- Department of Obstetrics and Gynaecology, Royal Prince Alfred Hospital, Sydney, Australia
| | - L Sunderland
- Department of Obstetrics and Gynaecology, Royal Prince Alfred Hospital, Sydney, Australia
| | - A Ferreira
- Sydney Ultrasound for Women, Sydney, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - M Menezes
- Monash Ultrasound for Women, Melbourne, Australia
| | - S Meagher
- Monash Ultrasound for Women, Melbourne, Australia
| | - A McLennan
- Sydney Ultrasound for Women, Sydney, Australia
- School of Women's and Children's Health, University of Sydney, Sydney, Australia
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Rogers R, Mardy A. Chorionic Villous Testing Versus Amniocentesis After Abnormal Noninvasive Prenatal Testing. Clin Obstet Gynecol 2023; 66:595-606. [PMID: 37650670 DOI: 10.1097/grf.0000000000000801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
In the setting of a normal first-trimester ultrasound, an amniocentesis may be a better option than chorionic villous sampling for invasive diagnostic testing after a cell-free DNA high risk for trisomy 13, given the high rates of confined placental mosaicism. In unaffected fetuses, other evaluations should be considered depending on the cell-free DNA results, including maternal karyotyping for monosomy X, uniparental disomy testing for chromosomes with imprinted genes, serial growth scans for trisomy 16, and a workup for maternal malignancy for multiple aneuploidies or autosomal monosomy.
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Affiliation(s)
- Rosemary Rogers
- Department of Women's Health, Dell Medical School-UT Health Austin, Austin, Texas
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Hong K, Park HJ, Jang HY, Shim SH, Jang Y, Kim SH, Cha DH. A Novel Paradigm for Non-Invasive Prenatal Genetic Screening: Trophoblast Retrieval and Isolation from the Cervix (TRIC). Diagnostics (Basel) 2023; 13:2532. [PMID: 37568895 PMCID: PMC10417081 DOI: 10.3390/diagnostics13152532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
As the prevalence of pregnancies with advanced maternal age increases, the risk of fetal chromosomal abnormalities is on the rise. Therefore, prenatal genetic screening and diagnosis have become essential elements in contemporary obstetrical care. Trophoblast retrieval and isolation from the cervix (TRIC) is a non-invasive procedure that can be utilized for prenatal genetic diagnosis. The method involves the isolation of fetal cells (extravillous trophoblasts) by transcervical sampling; along with its non-invasiveness, TRIC exhibits many other advantages such as its usefulness in early pregnancy at 5 weeks of gestation, and no interference by various fetal and maternal factors. Moreover, the trophoblast yields from TRIC can provide valuable information about obstetrical complications related to abnormal placentation even before clinical symptoms arise. The standardization of this clinical tool is still under investigation, and the upcoming advancements in TRIC are expected to meet the increasing need for a safe and accurate option for prenatal diagnosis.
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Affiliation(s)
- Kirim Hong
- CHA Gangnam Medical Center, Department of Obstetrics and Gynecology, CHA University, Seoul 06125, Republic of Korea; (K.H.); (H.J.P.); (Y.J.)
| | - Hee Jin Park
- CHA Gangnam Medical Center, Department of Obstetrics and Gynecology, CHA University, Seoul 06125, Republic of Korea; (K.H.); (H.J.P.); (Y.J.)
| | - Hee Yeon Jang
- Department of Biomedical Science, College of Life Science, CHA University, Seongnam 13488, Republic of Korea; (H.Y.J.); (S.H.S.)
| | - Sung Han Shim
- Department of Biomedical Science, College of Life Science, CHA University, Seongnam 13488, Republic of Korea; (H.Y.J.); (S.H.S.)
| | - Yoon Jang
- CHA Gangnam Medical Center, Department of Obstetrics and Gynecology, CHA University, Seoul 06125, Republic of Korea; (K.H.); (H.J.P.); (Y.J.)
| | - Soo Hyun Kim
- CHA Gangnam Medical Center, Department of Obstetrics and Gynecology, CHA University, Seoul 06125, Republic of Korea; (K.H.); (H.J.P.); (Y.J.)
| | - Dong Hyun Cha
- CHA Gangnam Medical Center, Department of Obstetrics and Gynecology, CHA University, Seoul 06125, Republic of Korea; (K.H.); (H.J.P.); (Y.J.)
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Hui L, Ellis K, Mayen D, Pertile MD, Reimers R, Sun L, Vermeesch J, Vora NL, Chitty LS. Position statement from the International Society for Prenatal Diagnosis on the use of non-invasive prenatal testing for the detection of fetal chromosomal conditions in singleton pregnancies. Prenat Diagn 2023; 43:814-828. [PMID: 37076973 DOI: 10.1002/pd.6357] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 04/15/2023] [Indexed: 04/21/2023]
Abstract
Key points
What is already known about this topic?
In 2015, the International Society for Prenatal Diagnosis (ISPD) published its first position statement on the use of non‐invasive prenatal testing (NIPT) to screen for aneuploidy. Widespread uptake across the globe and subsequent published research has shed new light on test performance and implementation issues.
What does this study add?
This new position statement replaces the 2015 statement with updated information on the current technologies, clinical experience, and implementation practices.
As an international organization, ISPD recognizes that there are important population‐specific considerations in the organization of prenatal screening and diagnosis. These opinions are designed to apply to high income settings where prenatal screening for aneuploidy is an established part of antenatal care.
This position statement is not a clinical practice guideline but represents the consensus opinion of the current ISPD Board based on the current state of knowledge and clinical practice.
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Affiliation(s)
- Lisa Hui
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
- Reproductive Epidemiology Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Perinatal Medicine, Mercy Hospital for Women, Heidelberg, Victoria, Australia
- Department of Obstetrics and Gynaecology, Northern Health, Epping, Victoria, Australia
| | - Katie Ellis
- Illumina ANZ, Sydney, New South Wales, Australia
| | - Dora Mayen
- Genetics Clinic, Hospital Angeles Lomas, Estado de Mexico, Mexico
| | - Mark D Pertile
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Rebecca Reimers
- San Diego Perinatal Center, Rady Children's Hospital, San Diego, California, USA
- Scripps Research Institute, La Jolla, California, USA
| | - Luming Sun
- Department of Fetal Medicine & Prenatal Diagnosis Center, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | | | - Neeta L Vora
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Division of Maternal Fetal Medicine, Chapel Hill, North Carolina, USA
| | - Lyn S Chitty
- Great Ormond Street NHS Foundation Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
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Chen K, Dunleavy BM, Talreja KL, Jones R. Differences of sexual development: genetic counseling considerations in the prenatal setting. Curr Opin Obstet Gynecol 2023; 35:127-133. [PMID: 36912347 DOI: 10.1097/gco.0000000000000853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
PURPOSE OF REVIEW With the rapid adoption of noninvasive prenatal screening (NIPS), predictive fetal sex information is available early in pregnancy. This information can conflict with the results of other prenatal tests such as fetal ultrasound or diagnostic testing and raise the possibility of a fetal difference of sexual development (DSD). In this review, we describe recent studies examining the counseling and outcomes of prenatally suspected DSD. RECENT FINDINGS Discordance in prenatal genetic testing results can cause confusion and anxiety in families as expectations of testing are not often discussed in detail prior to testing. There are no established guidelines for the counseling or management of such situations. SUMMARY We present case vignettes to highlight relevant counseling points and considerations to aid in the development of guidelines and best practices in the management of DSD in the prenatal setting.
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Affiliation(s)
| | | | - Karina L Talreja
- Perinatal Genetics, Stanford Medicine Children's Health, Palo Alto
| | - Renee Jones
- Roche Diagnostic Solutions, Clinical Development and Medical Affairs, Pleasanton, California
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De Falco L, Vitiello G, Savarese G, Suero T, Ruggiero R, Savarese P, Ianniello M, Petrillo N, Bruno M, Legnante A, Passaretti FF, Ardisia C, Di Spiezio Sardo A, Fico A. A Case Report of a Feto-Placental Mosaicism Involving a Segmental Aneuploidy: A Challenge for Genome Wide Screening by Non-Invasive Prenatal Testing of Cell-Free DNA in Maternal Plasma. Genes (Basel) 2023; 14:668. [PMID: 36980940 PMCID: PMC10048202 DOI: 10.3390/genes14030668] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 02/28/2023] [Accepted: 03/04/2023] [Indexed: 03/11/2023] Open
Abstract
Non-invasive prenatal testing (NIPT) using cell-free DNA can detect fetal chromosomal anomalies with high clinical sensitivity and specificity. In approximately 0.1% of clinical cases, the NIPT result and a subsequent diagnostic karyotype are discordant. Here we report a case of a 32-year-old pregnant patient with a 44.1 Mb duplication on the short arm of chromosome 4 detected by NIPT at 12 weeks' gestation. Amniocentesis was carried out at 18 weeks' gestation, followed by conventional and molecular cytogenetic analysis on cells from the amniotic fluid. SNP array analysis found a de novo deletion of 1.2 Mb at chromosome 4, and this deletion was found to be near the critical region of the Wolf-Hirschhorn syndrome. A normal 46,XY karyotype was identified by G-banding analysis. The patient underwent an elective termination and molecular investigations on tissues from the fetus, and the placenta confirmed the presence of type VI true fetal mosaicism. It is important that a patient receives counselling following a high-risk call on NIPT, with appropriate diagnostic analysis advised before any decisions regarding the pregnancy are taken. This case highlights the importance of genetic counselling following a high-risk call on NIPT, especially in light of the increasing capabilities of NIPT detection of sub-chromosomal deletions and duplications.
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Affiliation(s)
- Luigia De Falco
- AMES, Centro Polidiagnostico Strumentale, 80013 Naples, Italy
- Fondazione Genetica per la Vita Onlus, Via Cuma, 80132 Naples, Italy
| | - Giuseppina Vitiello
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University Hospital, Via Pansini 5, 80131 Naples, Italy
| | - Giovanni Savarese
- AMES, Centro Polidiagnostico Strumentale, 80013 Naples, Italy
- Fondazione Genetica per la Vita Onlus, Via Cuma, 80132 Naples, Italy
| | - Teresa Suero
- AMES, Centro Polidiagnostico Strumentale, 80013 Naples, Italy
- Fondazione Genetica per la Vita Onlus, Via Cuma, 80132 Naples, Italy
| | - Raffaella Ruggiero
- AMES, Centro Polidiagnostico Strumentale, 80013 Naples, Italy
- Fondazione Genetica per la Vita Onlus, Via Cuma, 80132 Naples, Italy
| | - Pasquale Savarese
- AMES, Centro Polidiagnostico Strumentale, 80013 Naples, Italy
- Fondazione Genetica per la Vita Onlus, Via Cuma, 80132 Naples, Italy
| | - Monica Ianniello
- AMES, Centro Polidiagnostico Strumentale, 80013 Naples, Italy
- Fondazione Genetica per la Vita Onlus, Via Cuma, 80132 Naples, Italy
| | - Nadia Petrillo
- AMES, Centro Polidiagnostico Strumentale, 80013 Naples, Italy
- Fondazione Genetica per la Vita Onlus, Via Cuma, 80132 Naples, Italy
| | - Mariasole Bruno
- AMES, Centro Polidiagnostico Strumentale, 80013 Naples, Italy
- Fondazione Genetica per la Vita Onlus, Via Cuma, 80132 Naples, Italy
| | - Antonietta Legnante
- Department of Public Health, University of Naples “Federico II”, 80145 Naples, Italy
| | - Francesco Fioravanti Passaretti
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University Hospital, Via Pansini 5, 80131 Naples, Italy
| | - Carmela Ardisia
- CRR Genetica Medica, Azienda Ospedaliera s. Maria della Misericordia, 06156 Perugia, Italy
| | | | - Antonio Fico
- AMES, Centro Polidiagnostico Strumentale, 80013 Naples, Italy
- Fondazione Genetica per la Vita Onlus, Via Cuma, 80132 Naples, Italy
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Bussolaro S, Raymond YC, Acreman ML, Guido M, Da Silva Costa F, Rolnik DL, Fantasia I. The accuracy of prenatal cell-free DNA screening for sex chromosome abnormalities: A systematic review and meta-analysis. Am J Obstet Gynecol MFM 2023; 5:100844. [PMID: 36572107 DOI: 10.1016/j.ajogmf.2022.100844] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/26/2022] [Accepted: 12/20/2022] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Although cell-free DNA screening for sex chromosome abnormalities is increasingly used in clinical practice, its diagnostic accuracy and clinical utility remain unclear. This systematic review and meta-analysis aimed to determine the performance of cell-free DNA in the detection of sex chromosome abnormalities. DATA SOURCES Medline and PubMed, Embase, and Web of Science were searched from inception to January 2022 for articles relating to cell-free DNA screening for sex chromosome abnormalities. STUDY ELIGIBILITY CRITERIA Original articles, randomized control trials, conference abstracts, cohort and case-control studies, and case series with more than 10 cases with diagnostic confirmation were considered for inclusion. METHODS Quality assessment of each included publication was performed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. The positive predictive value was calculated as the proportion of true positive cases among those who tested positive and underwent diagnostic testing. Sensitivity and specificity were pooled, and a summary receiver operating characteristic curve was produced using bivariate models that included studies that had diagnostic confirmation for high- and low-risk women. RESULTS The search identified 7553 results. Of these, 380 proceeded to the full-text screening, of which 94 articles were included in the meta-analysis with a total of 1,531,240 women tested. All studies reported a confirmatory genetic test. The pooled positive predictive value was 49.4% (95% confidence interval, 45.8-53.1). The pooled positive predictive value was 32.0% (95% confidence interval, 27.0%-37.3%) for monosomy X, 67.6% (95% confidence interval, 62.5%-72.5%) for XXY, 57.5% (95% confidence interval, 51.7%-63.1%) for XXX, and 70.9% (95% confidence interval, 63.9%-77.1%) for XYY. The pooled sensitivity and specificity of cell-free DNA for sex chromosome abnormalities were 94.1% (95% confidence interval, 90.8%-96.3%) and 99.5% (95% confidence interval, 99.0%-99.7%), respectively, with an area under the summary receiver operating characteristic curve of 0.934 (95% confidence interval, 0.907-0.989). CONCLUSION Although the sensitivity and specificity of cell-free DNA for sex chromosome abnormalities are high, the positive predictive value was approximately 50%. The positive predictive value was higher for sex chromosome abnormalities with a supernumerary Y chromosome and lower for monosomy X. Clinicians should inform couples about these findings when offering cell-free DNA for sex chromosome abnormalities.
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Affiliation(s)
- Sofia Bussolaro
- Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy (Dr Bussolaro)
| | - Yvette C Raymond
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia (Ms Raymond and Dr Rolnik)
| | - Melissa L Acreman
- Department of Obstetrics and Gynaecology, Ipswich Hospital, Queensland, Australia (Dr Acreman)
| | - Maurizio Guido
- Obstetrics and Gynaecology Unit, San Salvatore Hospital, L'Aquila, Italy (XX Guido and Dr Fantasia); Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy (XX Guido)
| | - Fabricio Da Silva Costa
- Maternal Fetal Medicine Unit, Gold Coast University Hospital, Gold Coast, Queensland, Australia (Dr Da Silva Costa); School of Medicine, Griffith University, Gold Coast, Queensland, Australia (Dr Da Silva Costa)
| | - Daniel L Rolnik
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia (Ms Raymond and Dr Rolnik); Monash Women's, Monash Health, Clayton, Australia (Dr Rolnik)
| | - Ilaria Fantasia
- Obstetrics and Gynaecology Unit, San Salvatore Hospital, L'Aquila, Italy (XX Guido and Dr Fantasia).
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Scarff KL, Flowers N, Love CJ, Archibald AD, Hunt CE, Giouzeppos O, Elliott J, Delatycki MB, Pertile MD. Performance of a cell-free DNA prenatal screening test, choice of prenatal procedure, and chromosome conditions identified during pregnancy after low-risk cell-free DNA screening. Prenat Diagn 2023; 43:213-225. [PMID: 36617980 DOI: 10.1002/pd.6307] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To evaluate the performance of cell-free DNA (cfDNA) screening for common fetal aneuploidies, choice of prenatal procedure, and chromosome conditions identified during pregnancy after low-risk cfDNA screening. METHOD A single-center prenatal cfDNA screening test was employed to detect trisomies 21, 18, and 13 (T21, T18, T13) and sex chromosome aneuploidies (SCAs). Test performance, choice of prenatal procedure, and cytogenetic results in pregnancies with low-risk cfDNA screening were reviewed. RESULTS CfDNA screening of 38,289 consecutive samples identified 720 (1.9%) pregnancies at increased risk for aneuploidy. Positive predictive values (PPVs) for high-risk singleton pregnancies were 98.5% (T21), 92.5% (T18) and 55.2% (T13). PPVs for SCAs ranged from 30.6% to 95.2%. Most women elected chorionic villus sampling for prenatal diagnosis of T21, T18 and T13; amniocentesis and/or postnatal testing were commonly chosen for SCAs. Cytogenetic tests from 616 screen-negative pregnancies identified 64 cases (12.7%) with chromosome conditions not detected by cfDNA screening, including triploidy (n = 30) and pathogenic and likely pathogenic copy number variants (n = 34). A further 15 (0.04%) false-negative common aneuploidy results were identified. CONCLUSIONS CfDNA screening was highly accurate for detecting fetal aneuploidy in this general-risk obstetric population. Fetal ultrasound and prenatal diagnostic testing were important in identifying chromosome conditions in pregnancies screened as low-risk.
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Affiliation(s)
- Katrina L Scarff
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Nicola Flowers
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Clare J Love
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Alison D Archibald
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Clare E Hunt
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Olivia Giouzeppos
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Justine Elliott
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Martin B Delatycki
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Bruce Lefroy Centre, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Mark D Pertile
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
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10
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Bedei I, Gehrke T, Gloning KP, Meyer-Wittkopf M, Willner D, Krapp M, Scharf A, Degenhardt J, Heling KS, Kozlowski P, Trautmann K, Jahns KM, Geipel A, Baumüller JE, Wilhelm L, Gottschalk I, Schröer A, Graf A, Wolter A, Schenk J, Weber A, Van den Veyver IB, Axt-Fliedner R. Multicenter clinical experience with non-invasive cell-free DNA screening for monosomy X and related X-chromosome variants. Prenat Diagn 2023; 43:192-206. [PMID: 36726284 DOI: 10.1002/pd.6320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We aimed to investigate how the presence of fetal anomalies and different X chromosome variants influences Cell-free DNA (cfDNA) screening results for monosomy X. METHODS From a multicenter retrospective survey on 673 pregnancies with prenatally suspected or confirmed Turner syndrome, we analyzed the subgroup for which prenatal cfDNA screening and karyotype results were available. A cfDNA screening result was defined as true positive (TP) when confirmatory testing showed 45,X or an X-chromosome variant. RESULTS We had cfDNA results, karyotype, and phenotype data for 55 pregnancies. cfDNA results were high risk for monosomy X in 48/55, of which 23 were TP and 25 were false positive (FP). 32/48 high-risk cfDNA cases did not show fetal anomalies. Of these, 7 were TP. All were X-chromosome variants. All 16 fetuses with high-risk cfDNA result and ultrasound anomalies were TP. Of fetuses with abnormalities, those with 45,X more often had fetal hydrops/cystic hygroma, whereas those with "variant" karyotypes had different anomalies. CONCLUSION Both, 45,X or X-chromosome variants can be detected after a high-risk cfDNA result for monosomy X. When there are fetal anomalies, the result is more likely a TP. In the absence of fetal anomalies, it is most often an FP or X-chromosome variant.
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Affiliation(s)
- Ivonne Bedei
- Department of Prenatal Medicine and Fetal Therapy, Justus-Liebig University, Giessen, Germany
| | - Tascha Gehrke
- Department of Prenatal Medicine and Fetal Therapy, Justus-Liebig University, Giessen, Germany
| | | | | | - Daria Willner
- Center for Prenatal Medicine and Human Genetics, Hamburg, Germany
| | - Martin Krapp
- Center for Prenatal Medicine on Elbe Hamburg, Hamburg, Germany
| | | | | | - Kai-Sven Heling
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
| | - Peter Kozlowski
- Prenatal Medicine and Genetics Düsseldorf, Praenatal.de, Duesseldorf, Germany
| | | | - Kai M Jahns
- Department of Internal Medicine, Johannes Gutenberg University, Mainz, Germany
| | - Annegret Geipel
- Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | | | | | - Ingo Gottschalk
- Division of Prenatal Medicine, Department of Obstetrics and Gynecology, University of Cologne, Cologne, Germany
| | | | - Alexander Graf
- Department of Prenatal Medicine and Fetal Therapy, Justus-Liebig University, Giessen, Germany
| | - Aline Wolter
- Department of Prenatal Medicine and Fetal Therapy, Justus-Liebig University, Giessen, Germany
| | - Johanna Schenk
- Department of Prenatal Medicine and Fetal Therapy, Justus-Liebig University, Giessen, Germany
| | - Axel Weber
- Department of Human Genetics, Justus-Liebig University, Giessen, Germany
| | - Ignatia B Van den Veyver
- Departments of Obstetrics and Gynecology and Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA.,Texas Children's Hospital, Houston, Texas, USA
| | - Roland Axt-Fliedner
- Department of Prenatal Medicine and Fetal Therapy, Justus-Liebig University, Giessen, Germany
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11
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Dowlut-McElroy T, Davis S, Howell S, Gutmark-Little I, Bamba V, Prakash S, Patel S, Fadoju D, Vijayakanthi N, Haag M, Hennerich D, Dugoff L, Shankar RK. Cell-free DNA screening positive for monosomy X: clinical evaluation and management of suspected maternal or fetal Turner syndrome. Am J Obstet Gynecol 2022; 227:862-870. [PMID: 35841934 PMCID: PMC9729468 DOI: 10.1016/j.ajog.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 01/27/2023]
Abstract
Initially provided as an alternative to evaluation of serum analytes and nuchal translucency for the assessment of pregnancies at high risk of trisomy 21, cell-free DNA screening for fetal aneuploidy, also referred to as noninvasive prenatal screening, can now also screen for fetal sex chromosome anomalies such as monosomy X as early as 9 to 10 weeks of gestation. Early identification of Turner syndrome, a sex chromosome anomaly resulting from the complete or partial absence of the second X chromosome, allows medical interventions such as optimizing obstetrical outcomes, hormone replacement therapy, fertility preservation and support, and improved neurocognitive outcomes. However, cell-free DNA screening for sex chromosome anomalies and monosomy X in particular is associated with high false-positive rates and low positive predictive value. A cell-free DNA result positive for monosomy X may represent fetal Turner syndrome, maternal Turner syndrome, or confined placental mosaicism. A positive screen for monosomy X with discordant results of diagnostic fetal karyotype presents unique interpretation and management challenges because of potential implications for previously unrecognized maternal Turner syndrome. The current international consensus clinical practice guidelines for the care of individuals with Turner syndrome throughout the lifespan do not specifically address management of individuals with a cell-free DNA screen positive for monosomy X. This study aimed to provide context and expert-driven recommendations for maternal and/or fetal evaluation and management when cell-free DNA screening is positive for monosomy X. We highlight unique challenges of cell-free DNA screening that is incidentally positive for monosomy X, present recommendations for determining if the result is a true-positive, and discuss when diagnosis of Turner syndrome is applicable to the fetus vs the mother. Whereas we defer the subsequent management of confirmed Turner syndrome to the clinical practice guidelines, we highlight unique considerations for individuals initially identified through cell-free DNA screening.
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Affiliation(s)
- Tazim Dowlut-McElroy
- Pediatric and Adolescent Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD; Department of Surgery, Children's National Hospital, Washington, DC.
| | - Shanlee Davis
- eXtraOrdinarY Kids Turner Syndrome Clinic, Children's Hospital Colorado, Aurora, CO; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Susan Howell
- eXtraOrdinarY Kids Turner Syndrome Clinic, Children's Hospital Colorado, Aurora, CO; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Iris Gutmark-Little
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Vaneeta Bamba
- Division of Endocrinology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Siddharth Prakash
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX
| | - Sheetal Patel
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Doris Fadoju
- Division of Pediatric Endocrinology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Nandini Vijayakanthi
- Division of Pediatric Endocrinology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA
| | - Mary Haag
- Colorado Genetics Laboratory, Department of Pathology, University of Colorado School of Medicine, Aurora, CO
| | - Deborrah Hennerich
- Colorado Genetics Laboratory, Department of Pathology, University of Colorado School of Medicine, Aurora, CO
| | - Lorraine Dugoff
- Divisions of Reproductive Genetics and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Roopa Kanakatti Shankar
- Division of Endocrinology, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC
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12
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Grati FR, Bestetti I, De Siero D, Malvestiti F, Villa N, Sala E, Crosti F, Parisi V, Nardone AM, Di Giacomo G, Pettinari A, Tortora G, Montaldi A, Calò A, Saccilotto D, Zanchetti S, Celli P, Guerneri S, Silipigni R, Cardarelli L, Lippi E, Cavani S, Malacarne M, Genesio R, Beltrami N, Pittalis MC, Desiderio L, Gentile M, Ficarella R, Recalcati MP, Catusi I, Garzo M, Miele L, Corti C, Ghezzo S, Bertini V, Cambi F, Valetto A, Facchinetti B, Bernardini L, Capalbo A, Balducci F, Pelo E, Minuti B, Pescucci C, Giuliani C, Renieri A, Longo I, Tita R, Castello G, Casalone R, Righi R, Raso B, Civolani A, Muzi MC, di Natale M, Varriale L, Gasperini D, Nuzzi MC, Cellamare A, Casieri P, Busuito R, Ceccarini C, Cesarano C, Privitera O, Melani D, Menozzi C, Falcinelli C, Calabrese O, Battaglia P, Tanzariello A, Stampalija T, Ardisia C, Gasparini P, Benn P, Novelli A. Positive predictive values and outcomes for uninformative cell-free DNA tests: An Italian multicentric Cytogenetic and cytogenomic Audit of diagnOstic testing (ICARO study). Prenat Diagn 2022; 42:1575-1586. [PMID: 36403097 DOI: 10.1002/pd.6271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To establish the positive predictive values (PPV) of cfDNA testing based on data from a nationwide survey of independent clinical cytogenetics laboratories. METHODS Prenatal diagnostic test results obtained by Italian laboratories between 2013 and March 2020 were compiled for women with positive non-invasive prenatal tests (NIPT), without an NIPT result, and cases where there was sex discordancy between the NIPT and ultrasound. PPV and other summary data were reviewed. RESULTS Diagnostic test results were collected for 1327 women with a positive NIPT. The highest PPVs were for Trisomy (T) 21 (624/671, 93%) and XYY (26/27, 96.3%), while rare autosomal trisomies (9/47, 19.1%) and recurrent microdeletions (8/55, 14.5%) had the lowest PPVs. PPVs for T21, T18, and T13 were significantly higher when diagnostic confirmation was carried out on chorionic villi (97.5%) compared to amniotic fluid (89.5%) (p < 0.001). In 19/139 (13.9%), of no result cases, a cytogenetic abnormality was detected. Follow-up genetic testing provided explanations for 3/6 cases with a fetal sex discordancy between NIPT and ultrasound. CONCLUSIONS NIPT PPVs differ across the conditions screened and the tissues studied in diagnostic testing. This variability, issues associated with fetal sex discordancy, and no results, illustrate the importance of pre- and post-test counselling.
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Affiliation(s)
- Francesca Romana Grati
- R&D, Cytogenetics, Molecular Genetics and Medical Genetics Unit, TOMA Advanced Biomedical Assays S.p.A, Busto Arsizio, Italy
| | - Ilaria Bestetti
- Laboratorio di Genetica Medica, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.,Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milan, Italy
| | - Daria De Siero
- R&D, Cytogenetics, Molecular Genetics and Medical Genetics Unit, TOMA Advanced Biomedical Assays S.p.A, Busto Arsizio, Italy
| | - Francesca Malvestiti
- R&D, Cytogenetics, Molecular Genetics and Medical Genetics Unit, TOMA Advanced Biomedical Assays S.p.A, Busto Arsizio, Italy
| | - Nicoletta Villa
- UOS Citogenetica e Genetica Medica - ASST-Monza, Ospedale San Gerardo, Università di Milano-Bicocca, Monza, Italy
| | - Elena Sala
- UOS Citogenetica e Genetica Medica - ASST-Monza, Ospedale San Gerardo, Università di Milano-Bicocca, Monza, Italy
| | - Francesca Crosti
- UOS Citogenetica e Genetica Medica - ASST-Monza, Ospedale San Gerardo, Università di Milano-Bicocca, Monza, Italy
| | - Valentina Parisi
- U.O.C. Laboratorio di Genetica Medica, Ospedale Pediatrico del Bambino Gesù, IRCCS, Roma, Italy
| | - Anna Maria Nardone
- U.O.C. Laboratorio di Genetica Medica, Policlinico Tor Vergata, Roma, Italy
| | | | - Antonella Pettinari
- SOSD Malattie Rare e Citogenetica, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Giada Tortora
- SOSD Malattie Rare e Citogenetica, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | | | - Annapaola Calò
- U.O.S. Laboratorio di Genetica, AULSS8 Berica, Vicenza, Italy
| | | | - Sara Zanchetti
- U.O.S. Laboratorio di Genetica, AULSS8 Berica, Vicenza, Italy
| | - Paola Celli
- U.O.S. Laboratorio di Genetica, AULSS8 Berica, Vicenza, Italy
| | - Silvana Guerneri
- Laboratorio di Genetica Medica, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Rosamaria Silipigni
- Laboratorio di Genetica Medica, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Laura Cardarelli
- Laboratorio di Genetica medica, Lifebrain, Gruppo Cerba HealthCare, c/o RDI, Rete Diagnostica Italiana, Limena, Italy
| | - Elisabetta Lippi
- Laboratorio di Genetica medica, Lifebrain, Gruppo Cerba HealthCare, c/o RDI, Rete Diagnostica Italiana, Limena, Italy
| | - Simona Cavani
- U.O.C. Laboratorio di Genetica Umana, IRCCS G. Gaslini, Genova, Italy
| | - Michela Malacarne
- U.O.C. Laboratorio di Genetica Umana, IRCCS G. Gaslini, Genova, Italy
| | - Rita Genesio
- DAI medicina di laboratorio e trasfusionale AOU Federico II, Napoli, Italy
| | | | - Maria Carla Pittalis
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy
| | - Laura Desiderio
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy
| | - Mattia Gentile
- Dipartimento di Medicina della Riproduzione, UOC Genetica Medica, ASL BARI, Bari, Italy
| | - Romina Ficarella
- Dipartimento di Medicina della Riproduzione, UOC Genetica Medica, ASL BARI, Bari, Italy
| | - Maria Paola Recalcati
- Laboratorio di Citogenetica e Genetica Molecolare, Istituto Auxologico Italiano, IRCCS, Milano, Italy
| | - Ilaria Catusi
- Laboratorio di Citogenetica e Genetica Molecolare, Istituto Auxologico Italiano, IRCCS, Milano, Italy
| | - Maria Garzo
- Laboratorio di Citogenetica e Genetica Molecolare, Istituto Auxologico Italiano, IRCCS, Milano, Italy
| | | | | | - Sara Ghezzo
- Laboratorio di Citogenetica - U.O.C. Genetica Medica, Centro Servizi Pievesestina - Laboratorio Unico, AUSL ROMAGNA, Cesena, Italy
| | - Veronica Bertini
- SOD Citogenetica, Azienda Ospedaliero Universitaria Pisana (AOUP), Pisa, Italy
| | - Francesca Cambi
- SOD Citogenetica, Azienda Ospedaliero Universitaria Pisana (AOUP), Pisa, Italy
| | - Angelo Valetto
- SOD Citogenetica, Azienda Ospedaliero Universitaria Pisana (AOUP), Pisa, Italy
| | - Barbara Facchinetti
- UOSD SMeL 4 Citogenetica e Genetica Medica, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Laura Bernardini
- Medical Genetics Division, IRCCS Casa Sollievo della Sofferenza Foundation, San Giovanni Rotondo, Italy
| | - Anna Capalbo
- Medical Genetics Division, IRCCS Casa Sollievo della Sofferenza Foundation, San Giovanni Rotondo, Italy
| | - Federica Balducci
- TECNOBIOS PRENATALE EUROGENLAB - Gruppo LIFE BRAIN Emilia-Romagna, Bologna, Italy
| | | | | | | | | | - Alessandra Renieri
- Medical Genetics, University of Siena, Siena, Italy.,Med Biotech Hub and Competence Center, Department of Medical Biotechnologies, University of Siena, Siena, Italy.,Genetica Medica, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Ilaria Longo
- Genetica Medica, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Rossella Tita
- Genetica Medica, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Giuseppe Castello
- Genetica Medica, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Rosario Casalone
- SSD SMeL Citogenetica e Genetica Medica, ASST dei Settelaghi, Varese, Italy
| | - Rossana Righi
- SSD SMeL Citogenetica e Genetica Medica, ASST dei Settelaghi, Varese, Italy
| | - Barbara Raso
- ASL ROMA 1, Centro S.Anna, Dipartimento dei Laboratori, U.O.S.D. di Genetica medica, Roma, Italy
| | - Alessandro Civolani
- ASL ROMA 1, Centro S.Anna, Dipartimento dei Laboratori, U.O.S.D. di Genetica medica, Roma, Italy
| | - Maria Cristina Muzi
- ASL ROMA 1, Centro S.Anna, Dipartimento dei Laboratori, U.O.S.D. di Genetica medica, Roma, Italy
| | - Manuela di Natale
- ASL ROMA 1, Centro S.Anna, Dipartimento dei Laboratori, U.O.S.D. di Genetica medica, Roma, Italy
| | - Luigia Varriale
- UOSD Diagnostica Alta Complessità, Settore Genetica, Azienda Ospedaliera Ospedali Riuniti Marche Nord-Pesaro, Nord-Pesaro, Italy
| | - Daniela Gasperini
- Laboratorio Genetica e Genomica, Ospedale Microcitemico A.Cao, ARNAS Brotzu Cagliari, Cagliari, Italy
| | - Maria Cristina Nuzzi
- UOC Patologia Clinica - Sezione di Genetica Medica, Ospedale SS. Annunziata Taranto - ASL TARANTO, Taranto, Italy
| | - Angelo Cellamare
- UOC Patologia Clinica - Sezione di Genetica Medica, Ospedale SS. Annunziata Taranto - ASL TARANTO, Taranto, Italy
| | - Paola Casieri
- UOC Patologia Clinica - Sezione di Genetica Medica, Ospedale SS. Annunziata Taranto - ASL TARANTO, Taranto, Italy
| | - Rosa Busuito
- Laboratorio di Genetica Molecolare e Citogenetica - Sezione di Citogenetica, UOC Laboratorio Analisi - ASST Ovest Milanese, Legnano, Italy
| | | | - Carla Cesarano
- U.O.C Genetica Medica, Policlinico Riuniti Foggia, Foggia, Italy
| | - Orsola Privitera
- SOS Genetica e Diagnostica di Laboratorio, Azienda USL Toscana Centro, Presidio Ospedale S. Stefano, Prato, Italy
| | - Daniela Melani
- SOS Genetica e Diagnostica di Laboratorio, Azienda USL Toscana Centro, Presidio Ospedale S. Stefano, Prato, Italy
| | - Cristina Menozzi
- SSD Genetica Medica, Dipartimento Materno Infantile, AOU Policlinico Modena, Modena, Italy
| | - Cristina Falcinelli
- SSD Genetica Medica, Dipartimento Materno Infantile, AOU Policlinico Modena, Modena, Italy
| | - Olga Calabrese
- SSD Genetica Medica, Dipartimento Materno Infantile, AOU Policlinico Modena, Modena, Italy
| | - Paola Battaglia
- Laboratorio di Genetica, UOC Genetica Medica, AUSL Imola, Imola, Italy
| | | | - Tamara Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy.,Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Carmela Ardisia
- Genetica Medica IRCCS Ospedale "Burlo Garofolo", Trieste, Italy
| | - Paolo Gasparini
- Genetica Medica IRCCS Ospedale "Burlo Garofolo", Trieste, Italy
| | - Peter Benn
- Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Antonio Novelli
- U.O.C. Laboratorio di Genetica Medica, Ospedale Pediatrico del Bambino Gesù, IRCCS, Roma, Italy
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14
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Mardy AH, Norton ME. Diagnostic testing after positive results on cell free DNA screening: CVS or Amnio? Prenat Diagn 2021; 41:1249-1254. [PMID: 34386984 DOI: 10.1002/pd.6021] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/03/2021] [Accepted: 07/06/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The positive predictive values of cell free DNA (cfDNA) and rates of confined placental mosaicism (CPM), imprinting and other factors vary by chromosome. METHODS We sought to review the literature for each of these features for each chromosome and provide recommendations on chorionic villus sampling (CVS) versus amniocentesis after an abnormal cfDNA result. RESULTS For chromosomes with high rates of CPM (trisomy 13, monosomy X and rare autosomal trisomies [RATs]), an amniocentesis should be considered if the first trimester ultrasound is normal. For monosomy X on cfDNA with an unaffected fetus, maternal karyotyping should be considered after normal fetal diagnostic testing. In cfDNA cases with a trisomy involving a chromosome with imprinted genes (6, 7, 11, 14, 15 and 20), CVS should be considered, followed by amniocentesis if abnormal. If the fetus is unaffected, methylation studies should be considered given the risk of uniparental disomy. A third trimester growth ultrasound should be considered for patients with a positive cfDNA screen for a RAT and an unaffected fetus, especially in the case of trisomy 16. For patients with multiple aneuploidy results on cfDNA, a work-up for maternal malignancy should be considered. CONCLUSIONS Clinicians should consider rates of CPM, imprinting, ultrasound findings and maternal factors when considering whether to recommend amniocentesis or CVS after an abnormal cfDNA result.
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Affiliation(s)
- Anne H Mardy
- Division of Maternal Fetal Medicine, University of California, San Francisco, California, USA
| | - Mary E Norton
- Division of Maternal Fetal Medicine, University of California, San Francisco, California, USA
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15
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Rosner M, Kolbe T, Hengstschläger M. Fetomaternal microchimerism and genetic diagnosis: On the origins of fetal cells and cell-free fetal DNA in the pregnant woman. MUTATION RESEARCH. REVIEWS IN MUTATION RESEARCH 2021; 788:108399. [PMID: 34893150 DOI: 10.1016/j.mrrev.2021.108399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 11/11/2021] [Accepted: 11/14/2021] [Indexed: 06/14/2023]
Abstract
During pregnancy several types of fetal cells and fetal stem cells, including pregnancy-associated progenitor cells (PAPCs), traffic into the maternal circulation. Whereas they also migrate to various maternal organs and adopt the phenotype of the target tissues to contribute to regenerative processes, fetal cells also play a role in the pathogenesis of maternal diseases. In addition, cell-free fetal DNA (cffDNA) is detectable in the plasma of pregnant women. Together they constitute the well-known phenomenon of fetomaternal microchimerism, which inspired the concept of non-invasive prenatal testing (NIPT) using maternal blood. An in-depth knowledge concerning the origins of these fetal cells and cffDNA allows a more comprehensive understanding of the biological relevance of fetomaternal microchimerism and has implications for the ongoing expansion of resultant clinical applications.
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Affiliation(s)
- Margit Rosner
- Institute of Medical Genetics, Center for Pathobiochemistry and Genetics, Medical University of Vienna, Vienna, Austria
| | - Thomas Kolbe
- Biomodels Austria, University of Veterinary Medicine Vienna, Vienna, Austria; Department IFA Tulln, University of Natural Resources and Life Sciences, Tulln, Austria
| | - Markus Hengstschläger
- Institute of Medical Genetics, Center for Pathobiochemistry and Genetics, Medical University of Vienna, Vienna, Austria.
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16
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Bianco K, Sherwin EB, Konigshofer Y, Girsen AI, Sylvester KG, Garlick RK. Novel Approaches to Develop Critical Reference Materials for Noninvasive Prenatal Testing: A Pilot Study. J Appl Lab Med 2021; 6:1492-1504. [PMID: 34080621 DOI: 10.1093/jalm/jfab037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/29/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Highly characterized reference materials are required to expand noninvasive prenatal testing (NIPT) for low incidence aneuploidies and microdeletions. The goal of this study was to develop reference materials for the development of next generation circulating cell-free DNA (ccfDNA) assays. METHODS This was a prospective study of pregnancies complicated by positive prenatal genetic screening. ccfDNA was isolated from maternal plasma and amplified. Lymphoblastoid cell lines were prepared from maternal peripheral blood mononuclear cells and fetal cord blood cells. Cells were Epstein-Barr virus immortalized and expanded. Amplified DNA and to a limited extent formulated lymphoblastoid-derived ccfDNA was tested in SNP-based and chromosome counting (CC) based massively parallel sequencing assays. RESULTS Enrolled cases included fetuses with: T21 (2), T18 (1), T18-XXX (1), XYY (1), microdeletions (1), and euploid (2). Three lymphoblastoid cells lines were prepared. Genomic DNA was extracted from cell lines and fragmented to simulate ccfDNA. ccfDNA isolation yielded about 2000 usable genome equivalents of DNA for each case for amplification. Although the sonicated genomic DNA derived from lymphoblastoid cell lines did not yield results compatible with NIPT assays, when blinded, NIPT platforms correctly identified the amplified ccfDNA isolated from blood in the majority of cases. CONCLUSIONS This study showed that maternal blood samples from pregnancies complicated by common chromosomal abnormalities can be used to generate materials for the development and evaluation of NIPT assays.
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Affiliation(s)
- Katherine Bianco
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Elizabeth B Sherwin
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Anna I Girsen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Karl G Sylvester
- Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
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Srebniak MI, Knapen MFCM, Joosten M, Diderich KEM, Galjaard S, Van Opstal D. Patient-friendly integrated first trimester screening by NIPT and fetal anomaly scan. Mol Cytogenet 2021; 14:4. [PMID: 33422094 PMCID: PMC7797124 DOI: 10.1186/s13039-020-00525-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/28/2020] [Indexed: 11/29/2022] Open
Abstract
Many major structural fetal anomalies can be diagnosed by first trimester fetal anomaly scan. NIPT can accurately detect aneuploidies and large chromosomal aberrations in cfDNA in maternal blood plasma. This study shows how a patient-friendly first trimester screening for both chromosomal and structural fetal anomalies in only two outpatient visits can be provided. Genotype-first approach assures not only the earliest diagnosis of trisomy 21 (the most prevalent chromosome aberration), but also completion of the screening at 12–14 weeks. To ensure proper management and avoid unnecessary anxiety abnormal NIPT different from trisomy 21, 18 and 13 should be referred for genetic counseling.
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Affiliation(s)
| | - Maarten F C M Knapen
- Department of Obstetrics and Fetal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Marieke Joosten
- Department of Clinical Genetics, Erasmus MC, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Karin E M Diderich
- Department of Clinical Genetics, Erasmus MC, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
| | - Sander Galjaard
- Department of Obstetrics and Fetal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Diane Van Opstal
- Department of Clinical Genetics, Erasmus MC, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands
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18
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Lu X, Wang C, Sun Y, Tang J, Tong K, Zhu J. Noninvasive prenatal testing for assessing foetal sex chromosome aneuploidy: a retrospective study of 45,773 cases. Mol Cytogenet 2021; 14:1. [PMID: 33407708 PMCID: PMC7786464 DOI: 10.1186/s13039-020-00521-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/09/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To assess the positive predictive value (PPV) of noninvasive prenatal testing (NIPT) as a screening test for sex chromosome aneuploidy (SCA) with different maternal characteristics and prenatal decisions in positive cases. MATERIALS AND METHODS We retrospectively analysed 45,773 singleton pregnancies with different characteristics that were subjected to NIPT in the Maternity and Child Health Hospital of Anhui Province. The results were validated by karyotyping. Clinical data, diagnostic results, and data on pregnancy outcomes were collected. RESULTS In total, 314 cases were SCA positive by NIPT; among those, 143 underwent invasive prenatal diagnostic testing, and 58 were true-positive. Overall, the PPVs for 45,X, 47,XXX, 47,XXY and 47,XYY were 12.5%, 51.72%, 66.67% and 83.33%, respectively. Interestingly, when only pregnant women of advanced maternal age (AMA) were screened, the PPVs for 45,X, 47,XXX, 47,XXY and 47,XYY were 23.81%, 53.33%, 78.95%, and 66.67%, respectively. The frequency of SCA was significantly higher in the AMA group than in the non-AMA group. The frequencies of 47,XXX and 47,XXY were significantly correlated with maternal age. CONCLUSION NIPT performed better in predicting sex chromosome trisomies than monosomy X, and patients with 45,X positive foetuses were more eager to terminate pregnancy than those with 47,XXX and 47,XYY. AMA may be a risk factor of having a foetus with SCA. Our findings may assist in genetic counselling of AMA pregnant women. Our pre- and posttest counselling are essential for familiarizing pregnant women with the benefits and limitations of NIPT, which may ease their anxiety and enable them to make informed choices for further diagnosis and pregnancy decisions.
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Affiliation(s)
- Xinran Lu
- Affiliated Maternity and Child Health Hospital of Anhui Medical University, Hefei, China.,Maternity and Child Health Hospital of Anhui Province, Hefei, China
| | - Chaohong Wang
- Maternity and Child Health Hospital of Anhui Province, Hefei, China
| | - Yuxiu Sun
- Maternity and Child Health Hospital of Anhui Province, Hefei, China
| | - Junxiang Tang
- Maternity and Child Health Hospital of Anhui Province, Hefei, China
| | - Keting Tong
- Maternity and Child Health Hospital of Anhui Province, Hefei, China
| | - Jiansheng Zhu
- Affiliated Maternity and Child Health Hospital of Anhui Medical University, Hefei, China. .,Maternity and Child Health Hospital of Anhui Province, Hefei, China.
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19
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Samura O, Okamoto A. Causes of aberrant non-invasive prenatal testing for aneuploidy: A systematic review. Taiwan J Obstet Gynecol 2020; 59:16-20. [PMID: 32039788 DOI: 10.1016/j.tjog.2019.11.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2019] [Indexed: 12/27/2022] Open
Abstract
Non-invasive prenatal testing (NIPT) is performed worldwide to detect common chromosomal aneuploidies. The analysis of cell-free DNA (cfDNA) in maternal blood for NIPT is highly accurate for the detection of the main fetal trisomies: 21,18, and 13. However, false-positive, false-negative, and non-reportable results can occur, and these can have biological causes. Understanding the causes of unexpected NIPT results is essential to enable clinicians and genetic counselors to counsel patients comprehensively and appropriately, both prior to testing as well as after receiving the test results. The classification of non-reportable results from cfDNA analysis is important in order to provide women with precise information. In addition to technical issues, there are biological reasons for discordant results, which can be either fetal or maternal in origin. Contributing fetal factors include insufficient or absent fetal fraction, fetoplacental mosaicism, and the presence of a vanishing twin. In some pregnant women that test positive for NIPT, multiple chromosome aneuploidy has been reported as a result of suspected malignancy, and cancer has been found. False-positive and false-negative results may be the result of placental biology and not a failure in the actual test platform. Explaining the placental origin of cfDNA provides the patient with a clear view of the abilities and limitations of cfDNA-based prenatal screening.
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Affiliation(s)
- Osamu Samura
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan.
| | - Aikou Okamoto
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
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20
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Abstract
Objective Non-invasive prenatal testing (NIPT) is increasingly being adopted as a screening test in the UK and is currently accessed through certain National Health Service healthcare systems or by private provision. This audit aims to describe reasons for and results of cytogenomic investigations carried out within UK genetic laboratories following an NIPT result indicating increased chance of cytogenomic abnormality (‘high-chance NIPT result’). Method A questionnaire was sent out to 24 genetics laboratories in the UK and completed by 18/24 (75%). Results Data were returned representing 1831 singleton pregnancies. A total of 1329 (73%) invasive samples were taken following NIPT results showing a high chance of trisomy 21; this was confirmed in 1305 (98%) of these by invasive sampling. Trisomy 21 was confirmed in >99% of patients who also had high-screen risk results or abnormal scan findings. Amongst invasive samples taken due to NIPT results indicating a high chance of trisomy 18, 84% yielded a compatible result, and this number dropped to 49% for trisomy 13 and 51% for sex chromosomes. Conclusion In the UK, the majority of patients having invasive sampling for high-chance NIPT results are doing so following an NIPT result indicating an increased chance of common trisomies (92%). In this population, NIPT performs particularly well for trisomy 21, but less well for other indications.
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21
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Van Opstal D, Eggenhuizen GM, Joosten M, Diderich K, Govaerts L, Galjaard RJ, Go A, Knapen M, Boter M, Cheung WY, van Koetsveld N, van Veen S, de Valk WG, Jehee F, de Vries F, Hollink I, Hoefsloot L, Srebniak M. Noninvasive prenatal testing as compared to chorionic villus sampling is more sensitive for the detection of confined placental mosaicism involving the cytotrophoblast. Prenat Diagn 2020; 40:1338-1342. [PMID: 32533714 PMCID: PMC7540368 DOI: 10.1002/pd.5766] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/28/2020] [Accepted: 06/10/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Diane Van Opstal
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Geerke M Eggenhuizen
- Department of Obstetrics and Fetal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marieke Joosten
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Karin Diderich
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Lutgarde Govaerts
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Robert-Jan Galjaard
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Attie Go
- Department of Obstetrics and Fetal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Maarten Knapen
- Department of Obstetrics and Fetal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marjan Boter
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Wai Y Cheung
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Nicole van Koetsveld
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Stefanie van Veen
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Walter G de Valk
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Fernanda Jehee
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Femke de Vries
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Iris Hollink
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Lies Hoefsloot
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Malgorzata Srebniak
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
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22
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Martin KA, Samango-Sprouse CA, Kantor V, Dhamankar R, Valenti E, Trefogli MT, Balosbalos I, Lagrave D, Lyons D, Kao C, Hakonarson H, Billings PR. Detection of maternal X chromosome abnormalities using single nucleotide polymorphism-based noninvasive prenatal testing. Am J Obstet Gynecol MFM 2020; 2:100152. [PMID: 33345882 DOI: 10.1016/j.ajogmf.2020.100152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/03/2020] [Accepted: 06/07/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Maternal X chromosome abnormalities may cause discordant results between noninvasive prenatal screening tests and diagnostic evaluation of the fetus/newborn, leading to unnecessary invasive testing. Women with X chromosome abnormalities are at increased risk for reproductive, pregnancy, or other health complications, which may be reduced or ameliorated by early diagnosis, monitoring, and intervention. OBJECTIVE This study aimed to validate a single nucleotide polymorphism-based noninvasive prenatal test to identify X chromosome abnormalities of maternal origin. STUDY DESIGN All tests unable to evaluate fetal risk for aneuploidy because of uninformative algorithm results were eligible for inclusion. Two groups of cases were prospectively identified: Group A (n=106) where a maternal X chromosome abnormality was suspected and Group B (control group, n=107) where a fetal chromosome abnormality involving chromosome 13, 18, 21, or X was suspected but did not meet criteria for reporting. Maternal DNA was isolated from the plasma-depleted cellular pellet and sent to a reference laboratory for blinded analysis using chromosomal microarray. A chromosome abnormality involving chromosomes 13, 18, 21, or X was reported by the reference laboratory if ≥5 Mb in size and present in ≥20% of the DNA. RESULTS A maternal X chromosome abnormality was suspected in 1/1305 tests (149/194,385; 0.08%). In Group A, a maternal X chromosome abnormality was confirmed in 100/106 cases (94.3% positive predictive value, 1-sided 97.5% confidence interval, 88.1%-100.0%). Turner syndrome was the most commonly suspected maternal abnormality (58/106, 54.7%), with confirmation of mosaic or nonmosaic 45,X by microarray in 38/58 (65.5%) cases. Noninvasive prenatal screening tests suspected the presence of maternal 47,XXX with or without mosaicism in 40/106 (37.7%) cases, confirmed by microarray in 38/40 (95.0%). In Group B (n=107), no maternal microarray abnormalities were reported, providing a negative predictive value of 100% (1-sided 97.5% confidence interval, 96.6%-100.0%). CONCLUSION When noninvasive prenatal testing suspected a maternal X chromosome abnormality, maternal microarray confirmed an X chromosome abnormality with 94.3% positive predictive value. Of the maternal X chromosome abnormalities detected by array, >50% were 45,X. When fetal chromosome abnormalities involving chromosomes 13, 18, 21, or X were suspected, no maternal chromosome abnormalities were reported, yielding a negative predictive value of 100%. Women with maternal X abnormalities suspected with noninvasive prenatal testing may be at increased risk for reproductive and health complications; early evaluation and treatment may prevent long-term consequences or disability.
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Affiliation(s)
| | - Carole A Samango-Sprouse
- Department of Pediatrics, George Washington University of Health Sciences, Washington, DC; The Focus Foundation, Davidsonville, MD; Department of Human and Molecular Genetics, Florida International University, Miami, FL
| | | | | | | | | | | | | | | | - Charlly Kao
- Center for Advanced Genomics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Hakon Hakonarson
- Center for Advanced Genomics, Children's Hospital of Philadelphia, Philadelphia, PA
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23
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Sacco A, Hewitt H, Pandya P. Women's choices in non-invasive prenatal testing for aneuploidy screening: results from a single centre prior to introduction in England. Arch Dis Child 2020; 105:47-52. [PMID: 31243005 DOI: 10.1136/archdischild-2019-317031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/28/2019] [Accepted: 06/04/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate patient choices and uptake of non-invasive prenatal testing (NIPT) for aneuploidy screening offered in a contingency model as part of routine care. METHOD We retrospectively reviewed data for all women with a singleton pregnancy attending for routine first trimester screening over an 18-month period. Women with a 'high-chance' of trisomy 21, 18 or 13 (≥1:150) were offered the choice of no further testing, NIPT or invasive testing, in line with the screening pathway recommended by the UK National Screening Committee. RESULTS Of 9342 women attending for a first trimester ultrasound scan, 7939 women were included in this study. Of these, 352 had a high-chance screening result for trisomy 21, and 291 (82.7%) opted for NIPT. The proportion of women opting for NIPT decreased as the chance of trisomy 21 increased: uptake was 93.2%, 90.0%, 77.1% and 47.2% for women with a chance of 1:100-150, 1:50-99, 1:10-49 and >1:10, respectively. 516 women (5.5%) accessed primary NIPT screening in the private sector, and 638 women (6.8%) declined any aneuploidy screening or testing. CONCLUSION Implementation of NIPT testing in a contingency model has a high uptake in a non-research National Health Service setting; the rate of uptake is related to the combined test risk result.
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Affiliation(s)
- Adalina Sacco
- Department of Maternal and Fetal Medicine, University College London Institute for Women's Health, London, UK.,Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - Hilary Hewitt
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - Pranav Pandya
- Department of Maternal and Fetal Medicine, University College London Institute for Women's Health, London, UK.,Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
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24
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Abstract
AbstractNon-invasive prenatal testing (NIPT) is a new technology used in prenatal testing (PT) that capitalizes on genomic platforms to transform DNA fragments in the blood of pregnant women into information about the genome of a foetus. Since its market introduction in 2011, it has travelled around the globe with remarkable speed. This article engages with the emergence of NIPT in and around Vienna, the capital city of Austria, to explore why and how this technology could travel so quickly in practice. Based on a qualitative analysis of interviews, documents, and field notes, it argues, first, that NIPT could travel so quickly because it travelled as ‘adaptable boxes’ that added on to different ‘local worlds of prenatal testing (PT)’, without disrupting them. Second, in so doing, NIPT could travel on a moral and material ground, or an ‘imaginary of PT’, built in the past. Third, the article argues that elements of this imaginary were also mobilized by commercial pioneers of NIPT, who ‘infrastructurized’ extant values, practices, and networks among biomedical professionals. Thus, various actors converged in mobilizing moral and material elements of an imaginary, transforming them into an infrastructure that facilitated the travels of NIPT, while also shaping its use.
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25
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Guseh SH. Noninvasive prenatal testing: from aneuploidy to single genes. Hum Genet 2019; 139:1141-1148. [PMID: 31555907 DOI: 10.1007/s00439-019-02061-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 09/04/2019] [Indexed: 12/16/2022]
Abstract
Noninvasive prenatal testing has undergone rapid advances in the last few years. Although researchers have long known about circulating pregnancy-based cell-free fragments of DNA in maternal plasma, it was the introduction of massively parallel sequencing that allowed noninvasive prenatal testing to become a widely used clinical test. This review will begin with an in-depth analysis of the use of noninvasive prenatal testing for aneuploidy, including common causes for inaccurate and/or discordant results. It will also review the ongoing expansion of noninvasive prenatal testing to include copy number variants and select single-gene disorders. Finally, integrated throughout the review is a comparison of noninvasive prenatal testing to more traditional screening methods along with some medical and ethical implications of the widespread use of this new technology.
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Affiliation(s)
- Stephanie H Guseh
- Division of Maternal-Fetal Medicine, Obstetrics and Gynecology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St, Boston, MA, USA.
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26
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Outcomes in pregnancies with a confined placental mosaicism and implications for prenatal screening using cell-free DNA. Genet Med 2019; 22:309-316. [PMID: 31391534 DOI: 10.1038/s41436-019-0630-y] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 07/26/2019] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To assess the association between confined placental mosaicism (CPM) and adverse pregnancy outcome. METHODS A retrospective cohort study was carried out evaluating the outcome of pregnancies with and without CPM involving a rare autosomal trisomy (RAT) or tetraploidy. Birthweight, gestational age at delivery, fetal growth restriction (FGR), Apgar score, neonatal intensive care admission, preterm delivery, and hypertensive disorders of pregnancy were considered. RESULTS Overall 181 pregnancies with CPM and 757 controls were recruited. Outcome information was available for 69% of cases (n = 124) and 62% of controls (n = 468). CPM involving trisomy 16 (T16) was associated with increased incidence of birthweight <3rd centile (P = 0.007, odds ratio [OR] = 11.2, 95% confidence interval [CI] = 2.7-47.1) and preterm delivery (P = 0.029, OR = 10.2, 95% CI = 1.9-54.7). For the other RATs, an association with prenatally diagnosed FGR was not supported by birthweight data and there were no other strong associations with adverse outcomes. CONCLUSION Excluding T16, the incidence of adverse pregnancy outcomes for pregnancies carrying a CPM is low. RATs can also be identified through genome-wide cell-free DNA screening. Because most of these will be attributable to CPMs, we conclude that this screening is of minimal benefit.
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27
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Zhen L, Yang Y, Li Y, Xu L, Li D. The role of ultrasound in the choice between chorionic villus sampling and amniocentesis for patients with a positive NIPT result for trisomy 18/13. Prenat Diagn 2019; 39:1155-1158. [PMID: 31299700 DOI: 10.1002/pd.5524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Li Zhen
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical CenterGuangzhou Medical University Guangzhou China
| | - Yan‐Dong Yang
- Department of UltrasoundThe Sixth Affiliated Hospital of Sun Yat‐sen University Guangzhou China
| | - Yu‐Juan Li
- Prenatal Diagnosis UnitDongguan Maternal and Children's Healthcare Hospital Dongguan China
| | - Li‐Li Xu
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical CenterGuangzhou Medical University Guangzhou China
| | - Dong‐Zhi Li
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical CenterGuangzhou Medical University Guangzhou China
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28
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Audibert F, De Bie I, Johnson JA, Okun N, Wilson RD, Armour C, Chitayat D, Kim R. No. 348-Joint SOGC-CCMG Guideline: Update on Prenatal Screening for Fetal Aneuploidy, Fetal Anomalies, and Adverse Pregnancy Outcomes. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 39:805-817. [PMID: 28859766 DOI: 10.1016/j.jogc.2017.01.032] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To review the available prenatal screening options in light of the recent technical advances and to provide an update of previous guidelines in the field of prenatal screening. INTENDED USERS Health care providers involved in prenatal screening, including general practitioners, obstetricians, midwives, maternal fetal medicine specialists, geneticists, and radiologists. TARGET POPULATION All pregnant women receiving counselling and providing informed consent for prenatal screening. EVIDENCE Published literature was retrieved through searches of Medline, PubMed, and the Cochrane Library in and prior to March 2016 using an appropriate controlled vocabulary (prenatal diagnosis, amniocentesis, chorionic villi sampling, non-invasive prenatal screening) and key words (prenatal screening, prenatal genetic counselling). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies written in English and published from January 1985 to May 2016. Searches were updated on a regular basis and incorporated in the guideline. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical speciality societies. GUIDELINE UPDATE Evidence will be reviewed 5 years after publication to determine whether all or part of the guideline should be updated. However, if important new evidence is published prior to the 5-year cycle, the review process may be accelerated for a more rapid update of some recommendations.
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29
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Bianchi DW. Turner syndrome: New insights from prenatal genomics and transcriptomics. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2019; 181:10.1002/ajmg.c.31675. [PMID: 30706680 PMCID: PMC10110351 DOI: 10.1002/ajmg.c.31675] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 12/30/2018] [Indexed: 01/08/2023]
Abstract
In some parts of the world, prenatal screening using analysis of circulating cell-free (cf) DNA in the plasma of pregnant women has become part of routine prenatal care with limited professional guidelines and without significant input from the Turner syndrome community. In contrast to the very high positive predictive values (PPVs) achieved with cfDNA analysis for trisomy 21 (91% for high-risk and 82% for low-risk cases), the PPVs for monosomy X are much lower (~26%). This is because the maternal plasma sample contains both maternal cfDNA and placental DNA, which is a proxy for the fetal genome. Underlying biological mechanisms for false positive monosomy X screening results include confined placental mosaicism, co-twin demise, and maternal mosaicism. Somatic loss of a single X chromosome in the mother is a natural phenomenon that occurs with aging; this could explain many of the false positive cfDNA results. There is also increased awareness of women who have constitutional mosaicism for 45, X who are fertile. It is important to recognize that a positive cfDNA screen for 45, X does not mean that the fetus has Turner syndrome. A follow-up diagnostic test, either amniocentesis or neonatal karyotype/chromosome microarray, is recommended. Research studies on cell-free mRNA in second trimester amniotic fluid, which is almost exclusively fetal, demonstrate consistent dysregulation of genes involved in the hematologic, immune, and neurologic systems. This suggests that some of the pathophysiology of Turner syndrome occurs early in fetal life and presents novel opportunities for consideration of antenatal treatments.
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Affiliation(s)
- Diana W Bianchi
- Section on Prenatal Genomics and Fetal Therapy, Medical Genetics Branch, National Human Genome Research Institute, and Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
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30
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Affiliation(s)
- Diana W Bianchi
- From the Prenatal Genomics and Fetal Therapy Section, Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD (D.W.B.); and the Li Ka Shing Institute of Health Sciences and the Department of Chemical Pathology, Chinese University of Hong Kong, Shatin, Hong Kong (R.W.K.C.)
| | - Rossa W K Chiu
- From the Prenatal Genomics and Fetal Therapy Section, Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD (D.W.B.); and the Li Ka Shing Institute of Health Sciences and the Department of Chemical Pathology, Chinese University of Hong Kong, Shatin, Hong Kong (R.W.K.C.)
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31
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Rieder W, White S, McGillivray G, Hui L. Contemporary prenatal aneuploidy screening practice in Australia: Frequently asked questions in the cell-free DNA era. Aust N Z J Obstet Gynaecol 2018; 58:397-403. [PMID: 29900540 DOI: 10.1111/ajo.12834] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 05/07/2018] [Indexed: 12/22/2022]
Abstract
Cell-free DNA screening has quickly become established in Australia as an accurate - albeit costly - prenatal screening test for trisomy 21, 18 and 13. It is also commonly used for the detection of sex chromosome abnormalities. The increasing number of prenatal screening pathways available to women has increased the complexity of pretest counselling. Concurrent advances in diagnostic testing with the widespread use of chromosomal microarrays create further challenges for the continuing education of clinicians and health consumers. This article aims to answer common clinical questions in this rapidly evolving field and complements the recently updated Royal Australian and New Zealand College of Obstetricians and Gynaecologists Statement on Prenatal Screening for Fetal Chromosome and Genetic Conditions.
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Affiliation(s)
- Wawrzyniec Rieder
- Mercy Perinatal, Mercy Hospital for Women, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynecology, CHUV, Lausanne, Switzerland
| | - Scott White
- Maternal Fetal Medicine Service, King Edward Memorial Hospital, Perth, Western Australia, Australia.,Division of Obstetrics and Gynecology, The University of Western Australia, Perth, Western Australia, Australia
| | - George McGillivray
- Mercy Perinatal, Mercy Hospital for Women, Melbourne, Victoria, Australia.,Public Health Genetics, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Lisa Hui
- Mercy Perinatal, Mercy Hospital for Women, Melbourne, Victoria, Australia.,Public Health Genetics, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynecology, University of Melbourne, Melbourne, Victoria, Australia.,Department of Obstetrics and Gynecology, The Northers Hospital, Melbourne, Victoria, Australia
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Brison N, Neofytou M, Dehaspe L, Bayindir B, Van Den Bogaert K, Dardour L, Peeters H, Van Esch H, Van Buggenhout G, Vogels A, de Ravel T, Legius E, Devriendt K, Vermeesch JR. Predicting fetoplacental chromosomal mosaicism during non-invasive prenatal testing. Prenat Diagn 2018; 38:258-266. [PMID: 29388226 DOI: 10.1002/pd.5223] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/14/2018] [Accepted: 01/23/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Non-invasive prenatal detection of aneuploidies can be achieved with high accuracy through sequencing of cell-free maternal plasma DNA in the maternal blood plasma. However, false positive and negative non-invasive prenatal testing (NIPT) results remain. Fetoplacental mosaicism is the main cause for false positive and false negative NIPT. We set out to develop a method to detect placental chromosomal mosaicism via genome-wide circulating cell-free maternal plasma DNA screening. METHOD Aneuploidy detection was combined with fetal fraction determination to enable the detection of placental mosaicism. This pipeline was applied to whole genome sequencing data derived from 19 735 plasma samples. Following an abnormal NIPT, test results were validated by conventional invasive prenatal or postnatal genetic testing. RESULTS Respectively 3.2% (5/154), 12.8% (5/39), and 13.3% (2/15) of trisomies 21, 18, and 13 were predicted and confirmed to be mosaic. The incidence of other, rare autosomal trisomies was ~0.3% (58/19,735), 45 of which were predicted to be mosaic. Twin pregnancies with discordant fetal genotypes were predicted and confirmed. CONCLUSION This approach permits the non-invasive detection of fetal autosomal aneuploidies and identifies pregnancies with a high risk of fetoplacental mosaicism. Knowledge about the presence of chromosomal mosaicism in the placenta influences risk estimation, genetic counseling, and improves prenatal management.
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Affiliation(s)
| | | | - Luc Dehaspe
- Centre for Human Genetics, KU Leuven, Leuven, Belgium
| | | | | | - Leila Dardour
- Department of Genetics, Faculty of Medicine "Ibn Al Jazzar", Sousse, Tunisia
| | - Hilde Peeters
- Centre for Human Genetics, KU Leuven, Leuven, Belgium
| | | | | | - Annick Vogels
- Centre for Human Genetics, KU Leuven, Leuven, Belgium
| | | | - Eric Legius
- Centre for Human Genetics, KU Leuven, Leuven, Belgium
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Goldwaser T, Klugman S. Cell-free DNA for the detection of fetal aneuploidy. Fertil Steril 2018; 109:195-200. [DOI: 10.1016/j.fertnstert.2017.12.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 12/14/2017] [Accepted: 12/14/2017] [Indexed: 10/18/2022]
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Grati FR, Bajaj K, Zanatta V, Malvestiti F, Malvestiti B, Marcato L, Grimi B, Maggi F, Simoni G, Gross SJ, Ferreira J. Implications of fetoplacental mosaicism on cell-free DNA testing for sex chromosome aneuploidies. Prenat Diagn 2017; 37:1017-1027. [PMID: 28801976 DOI: 10.1002/pd.5138] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/06/2017] [Accepted: 08/05/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The unique biological behavior of sex chromosomes has implications for cell-free DNA (cfDNA) testing. Our purpose is to predict the (1) false positive/negative rates of cfDNA testing consequent to fetoplacental mosaicism for any sex chromosome aneuploidies (SCA) and (2) positive predictive value (PPV) and negative predictive values of a high-risk and low-risk cfDNA result for any SCA. METHOD This is a retrospective analysis of 67 030 chorionic villus sampling karyotypes, including fetoplacental mosaicism cases. RESULTS Non-mosaic 45, X is associated with cystic hygroma/increased nuchal translucency and fetal anomalies. The false positive rate consequent to confined placental mosaicism is predicted to be 0.05%. The estimated false negative rate is in the range of 0% to 5.7% for all non-mosaic SCAs; it is 70% for mosaic 45, X with normal ultrasound. The predicted PPV on amniocytes is very high for most SCAs (94.4-99.4%). However, the stratified analysis shows that the PPV is much lower for 45, X without ultrasound anomalies compared with 45, X with abnormal scan (51% or 71%, vs 99%, respectively). CONCLUSION Mosaicism is a major issue for SCA cfDNA testing, and prenatal confirmation, preferentially with amniocentesis if there are no ultrasound anomalies, remains important in counseling. As PPV varies on the basis of the presence of an ultrasound anomaly, skilled evaluation is critical. © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
| | - Komal Bajaj
- Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Obstetrics and Gynecology, NYC Health + Hospitals/Jacobi, Bronx, NY, USA
| | - Valentina Zanatta
- TOMA, Advanced Biomedical Assays S.p.A., Busto Arsizio, Varese, Italy
| | | | | | - Livia Marcato
- TOMA, Advanced Biomedical Assays S.p.A., Busto Arsizio, Varese, Italy
| | - Beatrice Grimi
- TOMA, Advanced Biomedical Assays S.p.A., Busto Arsizio, Varese, Italy
| | - Federico Maggi
- TOMA, Advanced Biomedical Assays S.p.A., Busto Arsizio, Varese, Italy
| | - Giuseppe Simoni
- TOMA, Advanced Biomedical Assays S.p.A., Busto Arsizio, Varese, Italy
| | | | - Jose Ferreira
- Genomed SA, Warsaw, Poland.,ICOR - Instituto do Coração, Maputo, Mozambique.,Faculdade de Medicina da Universidade Eduardo Mondlane, Maputo, Mozambique
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35
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Audibert F, De Bie I, Johnson JA, Okun N, Wilson RD, Armour C, Chitayat D, Kim R. N o 348-Directive clinique de la SOGC et du CCGM : mise à jour sur le dépistage prénatal de l’aneuploïdie fœtale, des anomalies fœtales et des issues défavorables de la grossesse. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:818-832. [DOI: 10.1016/j.jogc.2017.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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36
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Dotters-Katz SK, Hardisty E, Campbell E, Vora N. Trisomy 13-confined placental mosaicism: is there an increased risk of gestational hypertensive disorders? Prenat Diagn 2017; 37:938-939. [PMID: 28671725 DOI: 10.1002/pd.5105] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 06/27/2017] [Accepted: 06/29/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Sarah K Dotters-Katz
- Division of Maternal Fetal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Emily Hardisty
- Division of Maternal Fetal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Erin Campbell
- Division of Maternal Fetal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Neeta Vora
- Division of Maternal Fetal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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37
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Cherry AM, Akkari YM, Barr KM, Kearney HM, Rose NC, South ST, Tepperberg JH, Meck JM. Diagnostic cytogenetic testing following positive noninvasive prenatal screening results: a clinical laboratory practice resource of the American College of Medical Genetics and Genomics (ACMG). Genet Med 2017; 19:845-850. [PMID: 28726804 DOI: 10.1038/gim.2017.91] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 05/11/2017] [Indexed: 01/05/2023] Open
Abstract
Disclaimer: ACMG Clinical Laboratory Practice Resources are developed primarily as an educational tool for clinical laboratory geneticists to help them provide quality clinical laboratory genetic services. Adherence to these practice resources is voluntary and does not necessarily assure a successful medical outcome. This Clinical Laboratory Practice Resource should not be considered inclusive of all proper procedures and tests or exclusive of other procedures and tests that are reasonably directed to obtaining the same results. In determining the propriety of any specific procedure or test, the clinical laboratory geneticist should apply his or her own professional judgment to the specific circumstances presented by the individual patient or specimen. Clinical laboratory geneticists are encouraged to document in the patient's record the rationale for the use of a particular procedure or test, whether or not it is in conformance with this Clinical Laboratory Practice Resource. They also are advised to take notice of the date any particular guideline was adopted, and to consider other relevant medical and scientific information that becomes available after that date. It also would be prudent to consider whether intellectual property interests may restrict the performance of certain tests and other procedures.Noninvasive prenatal screening (NIPS) using cell-free DNA has been rapidly adopted into prenatal care. Since NIPS is a screening test, diagnostic testing is recommended to confirm all cases of screen-positive NIPS results. For cytogenetics laboratories performing confirmatory testing on prenatal diagnostic samples, a standardized testing algorithm is needed to ensure that the appropriate testing takes place. This algorithm includes diagnostic testing by either chorionic villi sampling or amniocentesis samples and encompasses chromosome analysis, fluorescence in situ hybridization, and chromosomal microarray.
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Affiliation(s)
- Athena M Cherry
- Department of Pathology, Stanford University School of Medicine, Stanford Health Care, Stanford, California, USA
| | - Yassmine M Akkari
- Cytogenetics and Molecular Pathology, Legacy Laboratory Sciences, Legacy Health, Portland, Oregon, USA
| | - Kimberly M Barr
- Genetics Department, Kaiser Permanente, San Francisco, California, USA
| | - Hutton M Kearney
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Nancy C Rose
- Department of Obstetrics and Gynecology, University of Utah, Intermountain Healthcare University of Utah, Salt Lake City, Utah, USA
| | | | - James H Tepperberg
- Clinical Cytogenetics Laboratory, Laboratory Corporation of America, Research Triangle Park, North Carolina, USA
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Grati FR, Malvestiti F, Branca L, Agrati C, Maggi F, Simoni G. Chromosomal mosaicism in the fetoplacental unit. Best Pract Res Clin Obstet Gynaecol 2017; 42:39-52. [DOI: 10.1016/j.bpobgyn.2017.02.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 01/20/2017] [Accepted: 02/04/2017] [Indexed: 01/12/2023]
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39
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Skrzypek H, Hui L. Noninvasive prenatal testing for fetal aneuploidy and single gene disorders. Best Pract Res Clin Obstet Gynaecol 2017; 42:26-38. [DOI: 10.1016/j.bpobgyn.2017.02.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 02/21/2017] [Indexed: 01/16/2023]
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40
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Abstract
Noninvasive prenatal DNA testing is the vanguard of genomic medicine. In only four years, this screening test has revolutionized prenatal care globally and opened up new prospects for personalized medicine for the fetus. There are widespread implications for increasing the scope of human genetic variation that can be detected before birth, and for discovering more about maternofetal and placental biology. These include an urgent need to develop pretest education for all pregnant women and consistent post-test management recommendations for those with discordant test results. The reduction in invasive testing has had downstream effects on specialist training and caused many countries to re-examine their national approaches to prenatal screening. Finally, the accumulating datasets of genomic information on pregnant women and their fetuses raise ethical issues regarding consent for future data mining and intellectual property.
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Affiliation(s)
- Lisa Hui
- Department of Perinatal Medicine, Mercy Hospital for Women, Heidelberg, Victoria 3084, Australia;
- Translational Obstetrics Group, University of Melbourne, Heidelberg, Victoria 3084, Australia
- Public Health Genetics Group, Murdoch Childrens Research Institute, Parkville, Victoria 3052, Australia
| | - Diana W. Bianchi
- Mother Infant Research Institute, Tufts Medical Center, Boston, Massachusetts 02111;
- Division of Genetics, Department of Pediatrics, Floating Hospital for Children, Boston, Massachusetts 02111
- Tufts University School of Medicine, Boston, Massachusetts 02111
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41
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Ferreira JCP, Grati FR, Bajaj K, Malvestiti F, Grimi MB, Trotta A, Liuti R, Milani S, Branca L, Hartman J, Maggi F, Simoni G, Gross SJ. Frequency of fetal karyotype abnormalities in women undergoing invasive testing in the absence of ultrasound and other high-risk indications. Prenat Diagn 2016; 36:1146-1155. [PMID: 27770451 DOI: 10.1002/pd.4951] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 10/18/2016] [Accepted: 10/18/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVES No previous studies have reported the frequencies of individual chromosomal anomalies in normal-appearing fetuses stratified by maternal age (MA) and gestational age (GA). We therefore sought to (1) characterize the frequency of all fetal karyotype anomalies in sonographically normal appearing fetuses without pretest risk factors, and (2) assess MA and GA impact on the proportion of anomalies targeted by screening and consequent impact on residual risk following a negative result. METHODS Fetal karyotypes from samples without prior risk assessment or ultrasound anomalies were analyzed. We calculated, per single-year MA and in two GA intervals, the predicted frequency of each cytogenetic defect. RESULTS A total of 129 263 karyotypes were analyzed. The risk for significant, cytogenetically visible chromosomal anomalies, at 15 to 20 weeks GA, varies between 1/301 at MA of 18 years, and 1/9 at MA of 48 years. The proportion of clinically significant anomalies not addressed by current screening methods is 47% at MA of 18 years and 5% at MA of 48 years. CONCLUSIONS By determining frequencies for individual karyotype anomalies stratified by MA and GA, in the setting of normal-appearing fetuses, a more personalized risk assessment, including the residual risk after a normal fetal aneuploidy screening result, can be provided. © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Jose Carlos P Ferreira
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland.,Genomed S.A., Warsaw, Poland
| | - Francesca R Grati
- Toma Advanced Biomedical Assays, Research and Development, Cytogenetics and Molecular Biology, Busto Arsizio, Varese, Italy
| | - Komal Bajaj
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Francesca Malvestiti
- Toma Advanced Biomedical Assays, Research and Development, Cytogenetics and Molecular Biology, Busto Arsizio, Varese, Italy
| | - Maria Beatrice Grimi
- Toma Advanced Biomedical Assays, Research and Development, Cytogenetics and Molecular Biology, Busto Arsizio, Varese, Italy
| | - Anna Trotta
- Toma Advanced Biomedical Assays, Research and Development, Cytogenetics and Molecular Biology, Busto Arsizio, Varese, Italy
| | - Rosaria Liuti
- Toma Advanced Biomedical Assays, Research and Development, Cytogenetics and Molecular Biology, Busto Arsizio, Varese, Italy
| | - Silvia Milani
- Toma Advanced Biomedical Assays, Research and Development, Cytogenetics and Molecular Biology, Busto Arsizio, Varese, Italy
| | - Lara Branca
- Toma Advanced Biomedical Assays, Research and Development, Cytogenetics and Molecular Biology, Busto Arsizio, Varese, Italy
| | - Jacob Hartman
- M.D. Candidate, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Federico Maggi
- Toma Advanced Biomedical Assays, Research and Development, Cytogenetics and Molecular Biology, Busto Arsizio, Varese, Italy
| | - Giuseppe Simoni
- Toma Advanced Biomedical Assays, Research and Development, Cytogenetics and Molecular Biology, Busto Arsizio, Varese, Italy
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42
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Oepkes D, Page-Christiaens GCL, Bax CJ, Bekker MN, Bilardo CM, Boon EMJ, Schuring-Blom GH, Coumans ABC, Faas BH, Galjaard RJH, Go AT, Henneman L, Macville MVE, Pajkrt E, Suijkerbuijk RF, Huijsdens-van Amsterdam K, Van Opstal D, Verweij EJJ, Weiss MM, Sistermans EA. Trial by Dutch laboratories for evaluation of non-invasive prenatal testing. Part I-clinical impact. Prenat Diagn 2016; 36:1083-1090. [PMID: 27750376 PMCID: PMC5214231 DOI: 10.1002/pd.4945] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 10/12/2016] [Accepted: 10/13/2016] [Indexed: 12/15/2022]
Abstract
Objective To evaluate the clinical impact of nationwide implementation of genome‐wide non‐invasive prenatal testing (NIPT) in pregnancies at increased risk for fetal trisomies 21, 18 and 13 (TRIDENT study). Method Women with elevated risk based on first trimester combined testing (FCT ≥ 1:200) or medical history, not advanced maternal age alone, were offered NIPT as contingent screening test, performed by Dutch University Medical laboratories. We analyzed uptake, test performance, redraw/failure rate, turn‐around time and pregnancy outcome. Results Between 1 April and 1 September 2014, 1413/23 232 (6%) women received a high‐risk FCT result. Of these, 1211 (85.7%) chose NIPT. One hundred seventy‐nine women had NIPT based on medical history. In total, 1386/1390 (99.7%) women received a result, 6 (0.4%) after redraw. Mean turn‐around time was 14 days. Follow‐up was available in 1376 (99.0%) pregnancies. NIPT correctly predicted 37/38 (97.4%) trisomies 21, 18 or 13 (29/30, 4/4 and 4/4 respectively); 5/1376 (0.4%) cases proved to be false positives: trisomies 21 (n = 2), 18 (n = 1) and 13 (n = 2). Estimated reduction in invasive testing was 62%. Conclusion Introduction of NIPT in the Dutch National healthcare‐funded Prenatal Screening Program resulted in high uptake and a vast reduction of invasive testing. Our study supports offering NIPT to pregnant women at increased risk for fetal trisomy. © 2016 The Authors. Prenatal Diagnosis published by John Wiley & Sons, Ltd. © 2016 The Authors. Prenatal Diagnosis published by John Wiley & Sons, Ltd. What's already known about this topic?Non‐invasive prenatal testing (NIPT) for trisomies 21, 18 and 13 is mainly offered in a commercial setting. Offering NIPT to pregnant women at increased risk for fetal trisomy leads to a reduction in invasive testing.
What does this study adds?NIPT implemented as a contingent test under the umbrella of a national health authority‐supported fetal trisomy screening program facilitates optimal counseling with close to 100% follow‐up, results in 86% uptake and confirms a major reduction of invasive tests.
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Affiliation(s)
- Dick Oepkes
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Caroline J Bax
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands
| | - Mireille N Bekker
- Department of Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Catia M Bilardo
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Elles M J Boon
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Audrey B C Coumans
- Department of Obstetrics and Gynaecology, Maastricht UMC+, Maastricht, The Netherlands
| | - Brigitte H Faas
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Attie T Go
- Department of Obstetrics and Gynecology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Lidewij Henneman
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, The Netherlands
| | - Merryn V E Macville
- Department of Clinical Genetics, Maastricht UMC+, Maastricht, The Netherlands
| | - Eva Pajkrt
- Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Ron F Suijkerbuijk
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Diane Van Opstal
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - E J Joanne Verweij
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Marjan M Weiss
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, The Netherlands
| | - Erik A Sistermans
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, The Netherlands
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Lildballe DL, Vogel I, Lund ICB, Stornes I, Jørgensen MW, Vestergaard EM. Non-invasive prenatal testing offered as part of a combined first-trimester screening program identifies tetrasomy 18p in a high-risk pregnancy. Prenat Diagn 2016; 36:1112-1114. [PMID: 27743407 DOI: 10.1002/pd.4943] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 10/06/2016] [Accepted: 10/11/2016] [Indexed: 11/10/2022]
Affiliation(s)
| | - Ida Vogel
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
| | | | - Inger Stornes
- Department of Obstetrics and Gynecology, Regional Hospital Randers, Randers, Denmark
| | - Mette Warming Jørgensen
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark.,Department of Pathology Aarhus, University Hospital, Aarhus, Denmark
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Grati FR. Implications of fetoplacental mosaicism on cell-free DNA testing: a review of a common biological phenomenon. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:415-423. [PMID: 27240559 DOI: 10.1002/uog.15975] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 05/16/2016] [Accepted: 05/24/2016] [Indexed: 06/05/2023]
Affiliation(s)
- F R Grati
- Research and Development, Cytogenetics and Medical Genetics Unit, TOMA Advanced Biomedical Assays S.p.A., Busto Arsizio, Varese, Italy .
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45
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Quarello E, Jacquemard F, Ville Y. [Screening of aneuploidies in twin pregnancies in 2016: We may miss the boat if we fail to take action]. ACTA ACUST UNITED AC 2016; 44:457-60. [PMID: 27363614 DOI: 10.1016/j.gyobfe.2016.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Indexed: 10/21/2022]
Affiliation(s)
- E Quarello
- Unité d'échographie et de diagnostic prénatal, hôpital Saint-Joseph, 26, boulevard de Louvain, 13285 Marseille cedex 08, France; Institut de médecine de la reproduction, 6, rue Rocca, 13008 Marseille, France.
| | - F Jacquemard
- Centre de diagnostic prénatal, hôpital américain de Paris, 63, boulevard Victor-Hugo, 92200 Neuilly-sur-Seine, France
| | - Y Ville
- Service d'obstétrique et de médecine fœtale, université Paris Descartes, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France
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46
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Koumbaris G, Kypri E, Tsangaras K, Achilleos A, Mina P, Neofytou M, Velissariou V, Christopoulou G, Kallikas I, González-Liñán A, Benusiene E, Latos-Bielenska A, Marek P, Santana A, Nagy N, Széll M, Laudanski P, Papageorgiou EA, Ioannides M, Patsalis PC. Cell-Free DNA Analysis of Targeted Genomic Regions in Maternal Plasma for Non-Invasive Prenatal Testing of Trisomy 21, Trisomy 18, Trisomy 13, and Fetal Sex. Clin Chem 2016; 62:848-55. [DOI: 10.1373/clinchem.2015.252502] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 03/21/2016] [Indexed: 12/19/2022]
Abstract
Abstract
BACKGROUND
There is great need for the development of highly accurate cost effective technologies that could facilitate the widespread adoption of noninvasive prenatal testing (NIPT).
METHODS
We developed an assay based on the targeted analysis of cell-free DNA for the detection of fetal aneuploidies of chromosomes 21, 18, and 13. This method enabled the capture and analysis of selected genomic regions of interest. An advanced fetal fraction estimation and aneuploidy determination algorithm was also developed. This assay allowed for accurate counting and assessment of chromosomal regions of interest. The analytical performance of the assay was evaluated in a blind study of 631 samples derived from pregnancies of at least 10 weeks of gestation that had also undergone invasive testing.
RESULTS
Our blind study exhibited 100% diagnostic sensitivity and specificity and correctly classified 52/52 (95% CI, 93.2%–100%) cases of trisomy 21, 16/16 (95% CI, 79.4%–100%) cases of trisomy 18, 5/5 (95% CI, 47.8%–100%) cases of trisomy 13, and 538/538 (95% CI, 99.3%–100%) normal cases. The test also correctly identified fetal sex in all cases (95% CI, 99.4%–100%). One sample failed prespecified assay quality control criteria, and 19 samples were nonreportable because of low fetal fraction.
CONCLUSIONS
The extent to which free fetal DNA testing can be applied as a universal screening tool for trisomy 21, 18, and 13 depends mainly on assay accuracy and cost. Cell-free DNA analysis of targeted genomic regions in maternal plasma enables accurate and cost-effective noninvasive fetal aneuploidy detection, which is critical for widespread adoption of NIPT.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Egle Benusiene
- Department of Human and Medical Genetics, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Pietryga Marek
- Gynecology and Obstetrics, Poznan University of Medical Sciences, Poland
| | - Alfredo Santana
- Clinical Genetics, Childhood Hospital Materno-Infantil, Las Palmas GC, Canary Islands, Spain
| | - Nikoletta Nagy
- Department of Medical Genetics, University of Szeged, Szeged, Hungary
| | - Márta Széll
- Department of Medical Genetics, University of Szeged, Szeged, Hungary
| | - Piotr Laudanski
- Department of Perinatology and Obstetrics Medical University of Bialystok, Poland
| | | | | | - Philippos C Patsalis
- NIPD Genetics, Ltd, Nicosia, Cyprus
- The Cyprus Institute of Neurology and Genetics
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47
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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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48
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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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Snyder HL, Curnow KJ, Bhatt S, Bianchi DW. Follow-up of multiple aneuploidies and single monosomies detected by noninvasive prenatal testing: implications for management and counseling. Prenat Diagn 2016; 36:203-9. [PMID: 26785403 PMCID: PMC5067681 DOI: 10.1002/pd.4778] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 01/12/2016] [Accepted: 01/15/2016] [Indexed: 12/17/2022]
Abstract
Objectives To determine the underlying biological basis for noninvasive prenatal testing (NIPT) results of multiple aneuploidies or autosomal monosomies. Methods Retrospective analysis of 113,415 tests to determine the study cohort, consisting of 138 (0.12%) cases reported as a single autosomal monosomy (n = 65), single trisomy with a sex chromosome aneuploidy (n = 36), or with multiple aneuploidies (n = 37). Clinical outcome information was reviewed and stratified into eight categories according to whether the karyotype or sonographic information agreed or disagreed with sequencing results. Results Of 67 cases with fetal or neonatal karyotypes available, 16 (24%) were partially or fully concordant with the NIPT result, 4 (6%) had aneuploidy on a reference chromosome, and 47 (70%) had normal fetal chromosomes, in which 5/47 had maternal malignancies reported. One case of maternal mosaic trisomy 8 was also detected. Of cases with no fetal karyotype information, ten had an abnormal clinical outcome, one was a normal live birth, and one reported maternal malignancy. Conclusions Noninvasive prenatal test results of autosomal monosomy or multiple aneuploidies are rare but have a diversity of underlying biologic causes. Some reflect the fetal karyotype; some reflect the presence of other maternal or fetal chromosome abnormalities, and a small number are linked to maternal disease. © 2016 Illumina. Prenatal Diagnosis published by John Wiley & Sons, Ltd. What's already known about this topic?Noninvasive prenatal testing (NIPT) has been validated for common autosomal trisomies (trisomy 21, 18, and 13), sex chromosome aneuploidies, and a selection of microdeletion syndromes. NIPT findings that are discordant with the fetal karyotype can be because of biological reasons, such as confined placental mosaicism, maternal chromosome abnormalities, and other maternal conditions such as occult malignancy.
What does this study add?Clinical and karyotype outcome information for cases that received an NIPT result indicating an autosomal monosomy or multiple aneuploidies. Some autosomal monosomy and multiple aneuploidy results reflect the true fetal karyotype, and some are explained by other factors, such as other fetal or maternal chromosomal abnormalities or maternal disease. This information will help providers with post‐test counseling for these rare and unusual results.
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Affiliation(s)
| | | | | | - Diana W Bianchi
- Mother Infant Research Institute, Tufts Medical Center, Boston, MA, USA
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Deprest J, Ghidini A, Van Mieghem T, Bianchi DW, Faas B, Chitty LS. In case you missed it: the Prenatal Diagnosis
editors bring you the most significant advances of 2015. Prenat Diagn 2016; 36:3-9. [DOI: 10.1002/pd.4758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Jan Deprest
- Department of Obstetrics and Gynecology; University Hospitals Leuven; Leuven Belgium
- Academic Department Development and Regeneration, Biomedical Sciences; KU Leuven; Leuven Belgium
| | - Alessandro Ghidini
- Department of Obstetrics and Gynecology; Georgetown University Hospital; Washington DC USA
| | - Tim Van Mieghem
- Department of Obstetrics and Gynecology; University Hospitals Leuven; Leuven Belgium
- Academic Department Development and Regeneration, Biomedical Sciences; KU Leuven; Leuven Belgium
| | - Diana W. Bianchi
- Mother Infant Research Institute, Tufts Medical Center; Boston MA
- Floating Hospital for Children; Boston MA USA
| | - Brigitte Faas
- Department of Human Genetics; Radboud University Medical Centre; Nijmegen the Netherlands
| | - Lyn S. Chitty
- UCL Institute of Child Health; Great Ormond Street Hospital for Children and NHS Foundation Trust; London UK
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