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Schuler BA, Mosera M, Hatch LD, Grochowsky A, Wheeler F. Collaborative efforts to improve genetic testing in the neonatal intensive care unit. J Perinatol 2023; 43:1500-1505. [PMID: 37914812 DOI: 10.1038/s41372-023-01817-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/22/2023] [Accepted: 10/23/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE To reduce unnecessary simultaneous karyotype analysis and chromosomal microarray (CMA) testing in the neonatal intensive care unit (NICU). STUDY DESIGN This quality improvement study investigated the effect of collaborative efforts between the NICU, cytogenetics, and clinical genetics on numbers of genetic tests, rates of abnormal tests, and number of genetics consults comparing baseline and 5-month intervention periods. RESULTS Simultaneous karyotype analyses and CMAs decreased due to a decrease in karyotype testing (11.3% [68/600] vs. 0.98% [6/614], p < 0.01). Karyotype analyses were more likely to be abnormal (13.8% [12/87] vs. 64.0% [16/25], p < 0.01). Frequency of genetics consultation did not change (7.0% [42/600] vs. 9.4% [58/614], p = 0.12). CONCLUSION Collaborative efforts between the NICU, cytogenetics, and clinical genetics decreased redundant genetic testing, which demonstrated potential cost savings to our institution. Ongoing collaborative efforts could facilitate genetic testing practices in the NICU that readily evolve in tandem with genetic testing recommendations.
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Affiliation(s)
- Bryce A Schuler
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Mackenzie Mosera
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - L Dupree Hatch
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Angela Grochowsky
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ferrin Wheeler
- Department of Pathology, Vanderbilt University Medical Center, Nashville, TN, USA
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Sachdev R, Field M, Baynam GS, Beilby J, Berarducci M, Berman Y, Boughtwood T, Cusack MB, Fitzgerald V, Fletcher J, Freckmann M, Grainger N, Kirk E, Lundie B, Lunke S, McGregor L, Mowat D, Parasivam G, Tyrell V, Wallis M, White SM, S L Ma A. Paediatric genomic testing: Navigating medicare rebatable genomic testing. J Paediatr Child Health 2021; 57:477-483. [PMID: 33566436 PMCID: PMC8049061 DOI: 10.1111/jpc.15382] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 01/24/2021] [Indexed: 11/30/2022]
Abstract
Genomic testing for a genetic diagnosis is becoming standard of care for many children, especially those with a syndromal intellectual disability. While previously this type of specialised testing was performed mainly by clinical genetics teams, it is increasingly being 'mainstreamed' into standard paediatric care. With the introduction of a new Medicare rebate for genomic testing in May 2020, this type of testing is now available for paediatricians to order, in consultation with clinical genetics. Children must be aged less than 10 years with facial dysmorphism and multiple congenital abnormalities or have global developmental delay or moderate to severe intellectual disability. This rebate should increase the likelihood of a genetic diagnosis, with accompanying benefits for patient management, reproductive planning and diagnostic certainty. Similar to the introduction of chromosomal microarray into mainstream paediatrics, this genomic testing will increase the number of genetic diagnoses, however, will also yield more variants of uncertain significance, incidental findings, and negative results. This paper aims to guide paediatricians through the process of genomic testing, and represents the combined expertise of educators, clinical geneticists, paediatricians and genomic pathologists around Australia. Its purpose is to help paediatricians navigate choosing the right genomic test, consenting patients and understanding the possible outcomes of testing.
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Affiliation(s)
- Rani Sachdev
- Centre for Clinical Genetics, Sydney Children's Hospital‐RandwickSydney Children's Hospitals NetworkSydneyNew South WalesAustralia,School of Women's and Children's HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Mike Field
- Cancer GeneticsRoyal North Shore HospitalSydneyNew South WalesAustralia,GOLD ServiceHunter‐New England Health ServiceNewcastleNew South WalesAustralia
| | - Gareth S Baynam
- Department of HealthGenetic Services of Western AustraliaPerthWestern AustraliaAustralia
| | - John Beilby
- Department of Diagnostic GenomicsPathWest Laboratory MedicinePerthWestern AustraliaAustralia
| | - Maria Berarducci
- Health Education and Training Institute (HETI)NSW Health ServiceSydneyNew South WalesAustralia
| | - Yemima Berman
- Department of Clinical GeneticsRoyal North Shore HospitalSydneyNew South WalesAustralia,Sydney Medical SchoolUniversity of SydneySydneyNew South WalesAustralia
| | - Tiffany Boughtwood
- Australian GenomicsParkvilleVictoriaAustralia,Murdoch Children's Research InstituteParkvilleVictoriaAustralia
| | - Marie B Cusack
- NSW Health Centre for Genetics EducationRoyal North Shore HospitalSydneyNew South WalesAustralia
| | - Vanessa Fitzgerald
- Speciality Services and Technology Evaluation Unit, Strategic Reform and Planning BranchNSW Ministry of HealthSydneyNew South WalesAustralia
| | - Jeffery Fletcher
- Department of PaediatricsThe Tweed HospitalTweed HeadsNew South WalesAustralia
| | - Mary‐Louise Freckmann
- Department of Clinical GeneticsRoyal North Shore HospitalSydneyNew South WalesAustralia
| | - Natalie Grainger
- NSW Health Centre for Genetics EducationRoyal North Shore HospitalSydneyNew South WalesAustralia
| | - Edwin Kirk
- Centre for Clinical Genetics, Sydney Children's Hospital‐RandwickSydney Children's Hospitals NetworkSydneyNew South WalesAustralia,School of Women's and Children's HealthUniversity of New South WalesSydneyNew South WalesAustralia,Randwick Genomics LaboratoryNSW Health PathologySydneyNew South WalesAustralia
| | - Ben Lundie
- Pathology QueenslandRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - Sebastian Lunke
- Victorian Clinical Genetics ServicesMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Department of PathologyUniversity of MelbourneMelbourneVictoriaAustralia
| | - Lesley McGregor
- South Australian Clinical Genetics ServiceWomen's and Children's HospitalAdelaideSouth AustraliaAustralia
| | - David Mowat
- Centre for Clinical Genetics, Sydney Children's Hospital‐RandwickSydney Children's Hospitals NetworkSydneyNew South WalesAustralia,School of Women's and Children's HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Gayathri Parasivam
- NSW Health Centre for Genetics EducationRoyal North Shore HospitalSydneyNew South WalesAustralia
| | - Vanessa Tyrell
- Children's Cancer Institute. RandwickSydneyNew South WalesAustralia
| | - Mathew Wallis
- Tasmanian Clinical Genetics Service, Tasmanian Health ServiceRoyal Hobart HospitalHobartTasmaniaAustralia,School of MedicineThe University of TasmaniaHobartTasmaniaAustralia
| | - Susan M White
- Victorian Clinical Genetics ServicesMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia
| | - Alan S L Ma
- Specialty of Genomic MedicineUniversity of SydneySydneyNew South WalesAustralia,Department of Clinical Genetics, Children's Hospital WestmeadSydney Children's Hospitals NetworkSydneyNew South WalesAustralia
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McKay V, Efron D, Palmer EE, White SM, Pearson C, Danchin M. Current use of chromosomal microarray by Australian paediatricians and implications for the implementation of next generation sequencing. J Paediatr Child Health 2017; 53:650-656. [PMID: 28449382 DOI: 10.1111/jpc.13523] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 12/10/2016] [Accepted: 12/21/2016] [Indexed: 11/30/2022]
Abstract
AIM Chromosomal microarray (CMA) is an important diagnostic test for children with multiple congenital anomalies or certain developmental behavioural problems suggestive of an underlying genetic diagnosis. However, there are medical and ethical complexities to its use and few Australian policies to guide practice. We aimed to describe the current practice of Australian paediatricians in relation to CMA testing. We hypothesised that there are knowledge gaps in their use of CMA. METHODS Online survey completed between September 2015 and January 2016 by paediatricians in secondary care settings. Participants were members of the Australian Paediatric Research Network. One hundred and sixty five (43%) of 383 active members responded. Our main outcome measures comprised: (i) the indications for which paediatricians request CMA; (ii) their approach to consent; (iii) their interpretation of results; and (iv) their understanding of the impact on patient management. RESULTS A significant proportion of paediatricians (21-52%) did not regularly use CMA for conditions with established evidence of diagnostic yield. Paediatricians under-estimated the potential for CMA findings to alter patient management. There was wide variability in paediatricians' approach to consent, and low use of consent forms and fact sheets. Paediatricians reported difficulties interpreting CMA results, with high rates of referral to clinical genetics services. CONCLUSIONS The reported practice of Australian paediatricians is not consistent with international standards on CMA. Australian practice could be improved by a standardised approach to ordering CMA, consenting patients and interpreting results. We provide resources for CMA ordering and make recommendations about preparation for next generation sequencing.
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Affiliation(s)
- Victoria McKay
- Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Daryl Efron
- Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Elizabeth E Palmer
- Sydney Children's Hospital, Sydney, New South Wales, Australia.,Department of Women and Children's Health, Randwick Campus, University of New South Wales, Sydney, New South Wales, Australia.,Genetics of Learning Disability Service, Newcastle, New South Wales, Australia
| | - Susan M White
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Victorian Clinical Genetics Service, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Chris Pearson
- Department of General Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Margie Danchin
- Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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What Do Parents Think about Chromosomal Microarray Testing? A Qualitative Report from Parents of Children with Autism Spectrum Disorders. AUTISM RESEARCH AND TREATMENT 2016; 2016:6852539. [PMID: 27413549 PMCID: PMC4931081 DOI: 10.1155/2016/6852539] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/28/2016] [Accepted: 05/18/2016] [Indexed: 11/18/2022]
Abstract
Background. Chromosomal Microarray Analysis (CMA) is increasingly utilized to detect copy number variants among children and families affected with autism spectrum disorders (ASD). However, CMA is controversial due to possible ambiguous test findings, uncertain clinical implications, and other social and legal issues related to the test. Methods. Participants were parents of children with ASD residing in the North Eastern region of North Carolina, USA. We conducted individual, face-to-face interviews with 45 parents and inquired about their perceptions of CMA. Results. Three major themes dominated parents' perceptions of CMA. None of the parents had ever heard of the test before and the majority of the parents postulated positive attitudes toward the test. Parents' motivations in undergoing the test were attributed to finding a potential cause of ASD, to being better prepared for having another affected child, and to helping with future reproductive decisions. Perceived barriers included the cost of testing, risk/pain of CMA testing, and fear of test results. Conclusion. This study contributes to the understanding of psychosocial aspects and cultural influences towards adoption of genetic testing for ASD in clinical practice. Genetic education can aid informed decision-making related to CMA genetic testing among parents of children with ASD.
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Abstract
Over the last half century, knowledge about genetics, genetic testing, and its complexity has flourished. Completion of the Human Genome Project provided a foundation upon which the accuracy of genetics, genomics, and integration of bioinformatics knowledge and testing has grown exponentially. What is lagging, however, are efforts to reach and engage nurses about this rapidly changing field. The purpose of this article is to familiarize nurses with several frequently ordered genetic tests including chromosomes and fluorescence in situ hybridization followed by a comprehensive review of chromosome microarray. It shares the complexity of microarray including how testing is performed and results analyzed. A case report demonstrates how this technology is applied in clinical practice and reveals benefits and limitations of this scientific and bioinformatics genetic technology. Clinical implications for maternal-child nurses across practice levels are discussed.
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Edwards M, Brescianini S, Allgood C, Freelander M, Dunstan R, Patradoon-Ho P, Chin R, Morgan L, Pervez T, Legendre M, Burgess T, Amselem S, Whitehall J. Syndrome diagnosis with single-nucleotide polymorphism (SNP) microarray. J Paediatr Child Health 2016; 52:85-9. [PMID: 26228624 DOI: 10.1111/jpc.12981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Matthew Edwards
- Department of Clinical Genetics, Campbelltown Hospital, Campbelltown, New South Wales, Australia.,Department of Paediatrics, University of Western Sydney School of Medicine, Sydney, New South Wales, Australia
| | - Sally Brescianini
- Department of Clinical Genetics, Campbelltown Hospital, Campbelltown, New South Wales, Australia
| | - Catherine Allgood
- Department of Paediatrics, University of Western Sydney School of Medicine, Sydney, New South Wales, Australia
| | - Michael Freelander
- Department of Paediatrics, University of Western Sydney School of Medicine, Sydney, New South Wales, Australia
| | - Richard Dunstan
- Department of Paediatrics, University of Western Sydney School of Medicine, Sydney, New South Wales, Australia
| | - Patrick Patradoon-Ho
- Department of Paediatrics, University of Western Sydney School of Medicine, Sydney, New South Wales, Australia.,Department of Paediatrics, Mount Druitt Hospital, Mount Druitt, New South Wales, Australia
| | - Raymond Chin
- Department of Paediatrics, University of Western Sydney School of Medicine, Sydney, New South Wales, Australia
| | - Lucy Morgan
- Department of Respiratory Medicine, Concord Hospital, Sydney, New South Wales, Australia
| | - Tasnuba Pervez
- Department of Paediatrics, University of Western Sydney School of Medicine, Sydney, New South Wales, Australia
| | - Marie Legendre
- U.F. de Génétique Moléculaire, Hôpital Armand Trousseau, Paris, France
| | - Trent Burgess
- Molecular Cytogenetics, Victorian Clinical Genetics Services, Melbourne, Victoria, Australia
| | - Serge Amselem
- Service de Génétique et d'Embryologie Médicales, UMR_S933 INSERM/UPMC, Paris, France
| | - John Whitehall
- Department of Paediatrics, University of Western Sydney School of Medicine, Sydney, New South Wales, Australia
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Kirk EP. An explosion, a tsunami, a runaway train: half a century of genetics. J Paediatr Child Health 2015; 51:3-7. [PMID: 25586838 DOI: 10.1111/jpc.12799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2014] [Indexed: 11/30/2022]
Abstract
Let's face it. There is no way of writing about the last half century of genetics without getting a little bit excitable. All of the terms in the title of this piece have been used by otherwise level-headed geneticists to describe the pace of change in genetics over the past few years. The thing is--they are right. Genetics is moving faster and faster. Five years ago, few people would have predicted that we would be where we are today. Five years from now, presumably, it will seem like 2015 was some kind of Dark Age when nothing much was happening. So it would be easy to lose perspective on the achievements of the past, or to assume that nothing much was happening in genetics until recently. However, everything that is happening in genetics now rests on the foundations built up over the past century, and particularly the past half century. And through that time, this journal has been a part of that story.
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Affiliation(s)
- Edwin P Kirk
- Department of Medical Genetics, Sydney Children's Hospital, Sydney, New South Wales, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
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Das P, Jones D. Chromosomal microarray testing in children: experience from a New Zealand secondary care hospital. J Paediatr Child Health 2014; 50:574-5. [PMID: 25041300 DOI: 10.1111/jpc.12666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Pion Das
- Department of Paediatrics, Tauranga Hospital, Bay of Plenty District Health Board, Tauranga, New Zealand
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10
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Godfrey E, Clark P. Developing standards for chromosomal microarray testing counselling in paediatrics. Acta Paediatr 2014; 103:574-7. [PMID: 24528481 DOI: 10.1111/apa.12601] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 02/11/2014] [Indexed: 01/22/2023]
Abstract
UNLABELLED Chromosomal microarray testing (CMA) generally aids paediatric genetic diagnosis. However, pre-CMA counselling is important as results can be ambiguous, generate uncertainty and raise ethical issues. We developed standards for counselling and giving families results; using these we evaluated practice for children seen by the Auckland Developmental Paediatric team in 2011. Pretest discussion was documented in 14 of 28 subjects and potential outcomes in 4of 28. 8 of 28 received information leaflets, 1 of 28 gave signed consent. 3 of 3 with abnormal results and 4 of 5 with variants of unknown significance (VOUS) were offered clinical genetics referral. 8 of 20 families with normal results were written to; two with abnormal results were informed face-to-face and one in writing; most VOUS were communicated by phone, voicemail or letter. CONCLUSION CMA testing requires clear patient information sheets and in-depth pretest discussion for informed consent, timely feedback of results and genetics referral as appropriate. Authoritative guidelines and training are needed to strengthen CMA counselling.
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Affiliation(s)
- Emma Godfrey
- School of Medicine and Surgery; University of Birmingham; Birmingham UK
| | - Phillipa Clark
- Developmental Paediatrics, Starship Children's Health; Auckland New Zealand
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Palmer EE, Mowat D. Agenesis of the corpus callosum: a clinical approach to diagnosis. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2014; 166C:184-97. [PMID: 24866859 DOI: 10.1002/ajmg.c.31405] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This review article aims to guide the clinician in establishing a diagnosis in patients with agenesis of the corpus callosum (ACC), presenting antenatally or postnatally. ACC may be isolated, or occur in association with other neuroanatomical lesions and/or congenital anomalies, and has many different genetic causes. Neuropsychological outcome varies considerably from normal to profound intellectual disability depending on the etiology. Approximately 25% of individuals with antenatally diagnosed apparently isolated ACC have intellectual disability. Subtle neurological, social, and learning deficits may still occur in those with normal intelligence and longitudinal neurocognitive follow-up is recommended for all children with ACC. The finding of ACC should prompt detailed clinical assessment in order to determine and manage the underlying condition. It is recognized that genetic factors contribute to ACC in the vast majority of cases. Less commonly ACC can result from antenatal infections, vascular or toxic insults, and it is increasingly recognized that ACC, particularly isolated ACC, may be due to an interaction of a number of "modifier" genetic and environmental factors. There are a large number of genetic conditions in which ACC may be a feature. We suggest a diagnostic algorithm to help guide the clinician towards diagnosis, to provide outcome advice and to aid in genetic counseling.
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Turbitt E, Halliday J, Amor D, Metcalfe S. Preferences for results from genomic microarrays: comparing parents and health care providers. Clin Genet 2014; 87:21-9. [DOI: 10.1111/cge.12398] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 03/26/2014] [Accepted: 04/03/2014] [Indexed: 02/03/2023]
Affiliation(s)
- E. Turbitt
- Genetics Education and Health Research; Murdoch Childrens Research Institute; Melbourne VIC Australia
- Department of Paediatrics; The University of Melbourne; Melbourne VIC Australia
| | - J.L. Halliday
- Public Health Genetics; Murdoch Childrens Research Institute Melbourne, VIC Australia
- Department of Paediatrics; The University of Melbourne; Melbourne VIC Australia
| | - D.J. Amor
- Genetics Education and Health Research; Murdoch Childrens Research Institute; Melbourne VIC Australia
- Victorian Clinical Genetics Service; Melbourne, VIC Australia
| | - S.A. Metcalfe
- Genetics Education and Health Research; Murdoch Childrens Research Institute; Melbourne VIC Australia
- Department of Paediatrics; The University of Melbourne; Melbourne VIC Australia
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Palmer E, Speirs H, Taylor PJ, Mullan G, Turner G, Einfeld S, Tonge B, Mowat D. Changing interpretation of chromosomal microarray over time in a community cohort with intellectual disability. Am J Med Genet A 2013; 164A:377-85. [PMID: 24311194 DOI: 10.1002/ajmg.a.36279] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 08/12/2013] [Indexed: 01/20/2023]
Abstract
Chromosomal microarray (CMA) is the first-line diagnostic test for individuals with intellectual disability, autism, or multiple congenital anomalies, with a 10-20% diagnostic yield. An ongoing challenge for the clinician and laboratory scientist is the interpretation of variants of uncertain significance (VOUS)-usually rare, unreported genetic variants. Laboratories differ in their threshold for reporting VOUS, and clinical practice varies in how this information is conveyed to the family and what follow-up is arranged. Workflows, websites, and databases are constantly being updated to aid the interpretation of VOUS. There is a growing literature reporting new microdeletion and duplication syndromes, susceptibility, and modifier copy number variants (CNVs). Diagnostic methods are also evolving with new array platforms and genome builds. In 2010, high-resolution arrays (Affymetrix 2.7 M Oligo and SNP, 50 kB resolution) were performed on a community cohort of 67 individuals with intellectual disability of unknown aetiology. Three hundred and one CNVs were detected and analyzed using contemporary resources and a simple scoring system. Thirteen (19%) of the arrays were assessed as potentially pathogenic, 4 (6%) as benign and 50 (75%) of uncertain clinical significance. The CNV data were re-analyzed in 2012 using the contemporary interpretative resources. There was a statistically significant difference in the assessment of individual CNVs (P < 0.0001). An additional eight patients were reassessed as having a potentially pathogenic array (n = 21, 31%) and several additional susceptibility or modifier CNVs were identified. This study highlights the complexity involved in the interpretation of CMA and uniquely demonstrates how, even on the same array platform, it can be subject to change over time.
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Affiliation(s)
- Emma Palmer
- Department of Medical Genetics, Sydney Children's Hospital, NSW, Australia; School of Women's and Children's Health, The University of NSW, Sydney, NSW, Australia
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Key Informants’ Perspectives of Implementing Chromosomal Microarrays Into Clinical Practice in Australia. Twin Res Hum Genet 2013; 16:833-9. [DOI: 10.1017/thg.2013.43] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
High-resolution genomic tests have the potential to revolutionize healthcare by vastly improving mutation detection. The use of chromosomal microarray (CMA) represents one of the earliest examples of these new genomic tests being introduced and disseminated in the clinic. While CMA has clear advantages over traditional karyotyping in terms of mutation detection, little research has investigated the process by which CMA was implemented in clinical settings. Fifteen key informants, six clinicians, and nine laboratory scientists from four Australian states were interviewed about their experiences during and in the time since CMA was adopted for clinical use. Participants discussed challenges such as result interpretation and communication. Strengths were also highlighted, including the collaborative approaches of some centers. Clinical experiences and opinions can inform larger studies with a range of stakeholders, including patients. The historical perspectives from this retrospective study can be helpful in guiding the implementation of future genomic technologies such as whole exome/genome sequencing.
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Turbitt E, Amor DJ, Halliday JL, Metcalfe SA. Considerations for reporting genome results to patients. J Paediatr Child Health 2013; 49:82. [PMID: 23320589 DOI: 10.1111/jpc.12046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Erin Turbitt
- Genetics Education and Health Research; Murdoch Childrens Research Institute; Melbourne Victoria Australia
- Department of Paediatrics; University of Melbourne; Melbourne Victoria Australia
| | - David J Amor
- Clinical Genetics Research; Murdoch Childrens Research Institute; Melbourne Victoria Australia
- Department of Paediatrics; University of Melbourne; Melbourne Victoria Australia
| | - Jane L Halliday
- Public Health Genetics; Murdoch Childrens Research Institute; Melbourne Victoria Australia
- Department of Paediatrics; University of Melbourne; Melbourne Victoria Australia
| | - Sylvia A Metcalfe
- Genetics Education and Health Research; Murdoch Childrens Research Institute; Melbourne Victoria Australia
- Department of Paediatrics; University of Melbourne; Melbourne Victoria Australia
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