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Roberts AW, Maisenbacher MK, Parmar S, Wilkinson J, Poll S, Faulkner N, Prakash SK. Maternal Sex Chromosome Aneuploidy Identified through Noninvasive Prenatal Screening: Clinical Profile and Patient Experience. Am J Perinatol 2024; 41:e2574-e2581. [PMID: 37433314 DOI: 10.1055/a-2126-7476] [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] [Indexed: 07/13/2023]
Abstract
OBJECTIVE Noninvasive prenatal screening (NIPS) may incidentally identify maternal aneuploidies that have health implications. We evaluated patients' experience with counseling and follow-up diagnostic testing after NIPS flags a potential maternal sex chromosome aneuploidy (SCA). STUDY DESIGN Patients who underwent NIPS at two reference laboratories between 2012 and 2021 and had test results that were consistent with possible or probable maternal SCA were contacted with a link to an anonymous survey. Survey topics included demographics, health history, pregnancy history, counseling, and follow-up testing. RESULTS A total of 269 patients responded to the anonymous survey, and 83 of these individuals also completed one follow-up survey. Most received pretest counseling. A total of 80% were offered fetal genetic testing during the pregnancy, and 35% of patients completed diagnostic maternal testing. Monosomy X-related phenotypes such as short stature or hearing loss prompted follow-up testing that led to a diagnosis of monosomy X in 14 (6%) cases. CONCLUSION Follow-up counseling and testing after a high-risk NIPS result suggestive of maternal SCA is heterogenous in this cohort and may be frequently incomplete. Health outcomes may be affected by these results and additional research could improve the provision, delivery, and quality of posttest counseling. KEY POINTS · NIPS results showing potential SCA could have maternal health implications.. · Variations in counseling and testing after NIPS were observed for women with suspected SCA.. · Comprehensive counseling and diagnostic testing strategies are critical for these patients..
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Affiliation(s)
- Aaron W Roberts
- Department of Obstetrics and Gynecology, The University of Texas Health Science Center at Houston, Houston, Texas
| | | | | | | | - Sarah Poll
- Invitae, Inc., San Francisco, California
| | | | - Siddharth K Prakash
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
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Xie X, Tan W, Li F, Carrano E, Ramirez P, DiAdamo A, Grommisch B, Amato K, Chai H, Wen J, Li P. Diagnostic cytogenetic testing following positive noninvasive prenatal screening results of sex chromosome abnormalities: Report of five cases and systematic review of evidence. Mol Genet Genomic Med 2020; 8:e1297. [PMID: 32383339 PMCID: PMC7336728 DOI: 10.1002/mgg3.1297] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Follow-up cytogenetic analysis has been recommended for cases with positive noninvasive prenatal screening (NIPS) results. This study of five cases with numerical and structural sex chromosomal abnormalities (SCA) and a review of large case series of NIPS provided guidance to improve prenatal diagnosis for SCA. METHODS Following positive NIPS results for SCA, karyotype analysis, chromosomal microarray analysis (CMA), fluorescence in situ hybridization (FISH), and locus-specific quantitative PCR were performed on cultured amniocytes, chorionic villi cells, and stimulated lymphocytes. Review of large case series was performed to evaluate the NIPS positive rate, follow-up rate of cytogenetic analysis, positive predictive value (PPV) for major types of SCA, and relative frequencies of subtypes of major SCA. RESULTS Of the five cases with positive NIPS for SCA, case 1 showed a mosaic pattern of monosomy X and isodicentric Y; case 2 showed a mosaic pattern of monosomy X confined to the placenta; cases 3 and 4 had an isochromosome of Xq, and case 5 showed a derivative chromosome 14 from a Yq/14p translocation of maternal origin. Review of literature showed that mean positive rate of NIPS for SCA was 0.61%, follow-up rate of cytogenetics analysis was 76%, and mean PPV for SCA was 48%. Mosaic patterns and structural rearrangements involving sex chromosomes were estimated in 3%-20% and 3% of SCA cases, respectively. CONCLUSION These five cases further demonstrated the necessity to pursue follow-up cytogenetic analysis to characterize mosaic patterns and structural abnormalities involving sex chromosomes and their value for prenatal genetic counseling. A workflow showing the performance of current NIPS and cytogenetic analysis for SCA was summarized. These results could facilitate an evidence-based approach to guide prenatal diagnosis of SCA.
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Affiliation(s)
- Xiaolei Xie
- Department of GeneticsYale University School of MedicineNew HavenCTUSA
- Prenatal Diagnosis CenterThe Sixth Affiliated Hospital of Guangzhou Medical UniversityQingyuan People’s HospitalQingyuanGuangdongChina
| | - Weihe Tan
- Prenatal Diagnosis CenterThe Sixth Affiliated Hospital of Guangzhou Medical UniversityQingyuan People’s HospitalQingyuanGuangdongChina
| | - Fuguang Li
- Prenatal Diagnosis CenterThe Sixth Affiliated Hospital of Guangzhou Medical UniversityQingyuan People’s HospitalQingyuanGuangdongChina
| | - Eric Carrano
- Department of GeneticsYale University School of MedicineNew HavenCTUSA
- Diagnostic Genetics Sciences ProgramUniversity of ConnecticutStorrsCTUSA
| | - Paola Ramirez
- Department of GeneticsYale University School of MedicineNew HavenCTUSA
- Diagnostic Genetics Sciences ProgramUniversity of ConnecticutStorrsCTUSA
| | - Autumn DiAdamo
- Department of GeneticsYale University School of MedicineNew HavenCTUSA
| | | | - Katherine Amato
- Department of GeneticsYale University School of MedicineNew HavenCTUSA
| | - Hongyan Chai
- Department of GeneticsYale University School of MedicineNew HavenCTUSA
| | - Jiadi Wen
- Department of GeneticsYale University School of MedicineNew HavenCTUSA
| | - Peining Li
- Department of GeneticsYale University School of MedicineNew HavenCTUSA
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Fleddermann L, Hashmi SS, Stevens B, Murphy L, Rodriguez-Buritica D, Friel LA, Singletary C. Current genetic counseling practice in the United States following positive non-invasive prenatal testing for sex chromosome abnormalities. J Genet Couns 2019; 28:802-811. [PMID: 30946507 DOI: 10.1002/jgc4.1122] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 11/06/2022]
Abstract
The purpose of this study was to describe current genetic counseling practice in the United States following a non-invasive prenatal testing (NIPT) result positive for a sex chromosome abnormality (SCA). Screening for SCAs can be confounded by confined placental mosaicism, natural loss of the X chromosome from maternal cells during aging, and undiagnosed maternal SCA or copy number variant (CNV). Furthermore, with the exception of 45,X, individuals with SCAs usually have no ultrasound or postnatal findings. This makes follow-up for unresolved positive NIPT necessary; however, there are currently no clinical guidelines. This study used a cross-sectional design with an anonymous questionnaire to survey 176 genetic counselors. The majority of prenatal respondents always offered diagnostic testing (>88%) and anatomy ultrasound (~90%), but the percent consistently offering maternal karyotype (22%-52%) and postnatal evaluation (28%-87%) varied. Maternal karyotype was offered more often when NIPT was positive for 45,X or 47,XXX and patients had normal prenatal diagnostic testing (p < 0.02) or declined testing (p < 0.02). Offer of postnatal evaluation was more likely when diagnostic testing was declined (p < 0.001). The majority of pediatric providers always offered a postnatal karyotype for the newborn (>72%) but the percent offering maternal karyotype (6%-46%) varied widely. With the current inconsistencies, many newborns with undiagnosed SCAs who could benefit from growth hormone therapy, early intervention, and/or targeted surveillance may be missed. Therefore, there is a need for professional guidelines to help improve the consistency of clinical care for patients with NIPT results positive for SCAs.
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Affiliation(s)
- Lauren Fleddermann
- UTHealth Graduate School of Biomedical Sciences, MD Anderson Cancer Center, The University of Texas, Houston, Texas.,Maternal Fetal Medicine Clinic, North Memorial Health Hospital, Robbinsdale, Minnesota
| | - Syed Shahrukh Hashmi
- UTHealth Graduate School of Biomedical Sciences, MD Anderson Cancer Center, The University of Texas, Houston, Texas.,Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas
| | - Blair Stevens
- UTHealth Graduate School of Biomedical Sciences, MD Anderson Cancer Center, The University of Texas, Houston, Texas.,Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas
| | - Lauren Murphy
- UTHealth Graduate School of Biomedical Sciences, MD Anderson Cancer Center, The University of Texas, Houston, Texas.,Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas
| | - David Rodriguez-Buritica
- UTHealth Graduate School of Biomedical Sciences, MD Anderson Cancer Center, The University of Texas, Houston, Texas.,Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas
| | - Lara A Friel
- UTHealth Graduate School of Biomedical Sciences, MD Anderson Cancer Center, The University of Texas, Houston, Texas.,Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas
| | - Claire Singletary
- UTHealth Graduate School of Biomedical Sciences, MD Anderson Cancer Center, The University of Texas, Houston, Texas.,Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas.,Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas
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Non-invasive prenatal aneuploidy testing: Critical diagnostic performance parameters predict sample z-score values. Clin Biochem 2018; 59:69-77. [PMID: 29958880 DOI: 10.1016/j.clinbiochem.2018.06.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/21/2018] [Accepted: 06/22/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Non-invasive prenatal aneuploidy testing (NIPT) by next-generation sequencing of circulating cell-free DNA in maternal plasma relies on chromosomal ratio (chrratio) measurements to detect aneuploid values that depart from euploid ratios. Diagnostic performances are known to depend on the fraction of fetal DNA (FF) present in maternal plasma, although how this translates into specific quantitative changes in specificity/positive predictive values and which other variables might also be important is not well understood. DESIGN & METHODS To explore this issue, theoretical relationships between FF and various measures of diagnostic performances were assessed for a range of parameter values. Empirical data from three NIPT assays were then used to validate theoretical calculations. RESULTS For a given positivity threshold, dramatic changes in specificity and positive predictive values (PPV) as a function of both FF and the coefficient of variation (CV) of the chrratio measurement were observed. Theoretically predicted and observed chrratio z-scores agreed closely, confirming the determinant impact of small changes in both FF and chrratio CV. CONCLUSIONS Evaluation of NIPT assay performances therefore requires knowledge of the FF distribution in the population in which the test is intended to be used and, in particular, of the precise value of the assay chrratio CV for each chromosome or genomic region of interest. Laboratories offering NIPT testing should carefully measure these parameters to ensure test reliability and clinical usefulness in interpreting individual patients' results.
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Mizia K, Townsend L, Karatas J. Sex chromosome aneuploidy screening in a general population. Australas J Ultrasound Med 2016; 19:105-108. [PMID: 34760452 DOI: 10.1002/ajum.12019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Cell-free fetal DNA testing is being used in parallel or in contingency screening as part of the first trimester screen. The test has high sensitivity and specificity for the trisomies 21, 18 and 13. The test also offers the option of assessing sex chromosome aneuploidies (SCA) which are recognised to be the next most common group of aneuploidies in the live birth population. Companies that offer the sex chromosome assessment report an accuracy rate of above 99% and a significant number of high-risk results have been detected in a multi-site Australian ultrasound practice. A high proportion of these women underwent prenatal testing to further assess the sex chromosomes. This study reports the results of these invasive investigations and results show that many of the high-risk SCA results appear to be false positives. This study reports the clinical experience of cell-free fetal DNA (cfDNA) testing with regard to sex chromosome aneuploidies in singleton pregnancies for a multi-site Sydney specialist O&G Ultrasound practice.
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Affiliation(s)
- Karen Mizia
- Ultrasound Care Randwick New South Wales Australia
| | - Lynn Townsend
- Ultrasound Care School of Women's and Children's Health Faculty of Medicine University of New South Wales, Australia
| | - Janan Karatas
- Ultrasound Care Northern Clinical School Sydney Medical School University of Sydney, Australia
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