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Matyszkiewicz A, Wiecheć M, Nocuń A. Re: Assay interference leading to erroneous pregnancy-associated plasma protein-A results. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:913. [PMID: 38041631 DOI: 10.1002/uog.27524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 09/22/2023] [Indexed: 12/03/2023]
Abstract
Linked article: This Correspondence comments on Jones et al. Click here to view the article.
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Affiliation(s)
| | - M Wiecheć
- Ultrasound Group Practice 'MWU DOBREUSG', Krakow, Poland
- Department of Gynecology and Obstetrics, Jagiellonian University Medical College, Krakow, Poland
- Centre of Postgraduate Medical Education, Warsaw, Poland
| | - A Nocuń
- Ultrasound Group Practice 'MWU DOBREUSG', Krakow, Poland
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Saito M, Tokunaka M, Goto M, Takita H, Arakaki T, Miyagami K, Hamada S, Oba T, Matsuoka R, Sekizawa A. The role of first-trimester ultrasound screening for women with positive noninvasive prenatal testing results. J Obstet Gynaecol Res 2021; 48:328-332. [PMID: 34918431 DOI: 10.1111/jog.15115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/19/2021] [Accepted: 11/22/2021] [Indexed: 11/29/2022]
Abstract
AIM This study aimed to assess the utility of ultrasound screening for pregnancies with positive noninvasive prenatal testing results for trisomy 21, trisomy 18, and trisomy 13. METHODS We performed a retrospective analysis of positive noninvasive prenatal testing results and first-trimester ultrasound screening at our department between 2013 and 2019. Invasive genetic testing was performed if the patient had positive noninvasive prenatal testing results. Fetal ultrasound and cytogenetic data were collected. Noninvasive prenatal testing was performed in the women for advanced maternal age, nuchal translucency thickness, or history of abnormality in the previous child or relative. RESULTS Forty-one pregnant women had positive noninvasive prenatal testing results for trisomy 21, trisomy 18, and trisomy 13. Twenty-three women had positive results for trisomy 21, 13 had positive results for trisomy 18, and 5 had positive results for trisomy 13 at 11 to 14 weeks of gestation. The positive predictive value of noninvasive prenatal testing was 100% for trisomy 21, 84.6% for trisomy 18, and 100% for trisomy 13. The positive predictive value of positive noninvasive prenatal testing results and fetal morphological abnormalities was 100% for trisomy 21, trisomy 18, and trisomy 13. CONCLUSION Combining an ultrasound examination with noninvasive prenatal testing resulted in a higher positive predictive value for trisomy 18. Normal ultrasound examination results can help alleviate stress caused by false-positive noninvasive prenatal testing results. In contrast, the positive predictive value and negative predictive value for trisomy 21 were not altered by adding an ultrasound examination to noninvasive prenatal testing.
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Affiliation(s)
- Mizue Saito
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Mayumi Tokunaka
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Minako Goto
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Hiroko Takita
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Tatsuya Arakaki
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Keiko Miyagami
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Shoko Hamada
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Tomohiro Oba
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Ryu Matsuoka
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
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Rajs B, Nocuń A, Matyszkiewicz A, Pasternok M, Kołodziejski M, Wiercińska E, Wiecheć M. First-trimester presentation of ultrasound findings in trisomy 13 and validation of multiparameter ultrasound-based risk calculation models to detect trisomy 13 in the late first trimester. J Perinat Med 2021; 49:341-352. [PMID: 33068386 DOI: 10.1515/jpm-2020-0383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/19/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To identify the most common ultrasound patterns of markers and anomalies associated with Patau syndrome (PS), to explore the efficacy of multiparameter sonographic protocols in detecting trisomy 13 (T13) and to analyze the influence of maternal age (MA) on screening performance. METHODS The project was a prospective study based on singleton pregnancies referred for a first-trimester screening examination. The scan protocol included nuchal translucency (NT), fetal heart rate (FHR), secondary ultrasound markers [nasal bone (NB), tricuspid regurgitation (TR), ductus venosus reversed a-wave (revDV)] and major anomaly findings. RESULTS The study population comprised 6133 pregnancies: 6077 cases of euploidy and 56 cases of T13. Statistically significant differences were found in MA, FHR, NT, absence of NB, presence of revDV, TR and single umbilical artery. Fourteen cases of T13 (25%) demonstrated no markers of aneuploidy. The best general detection rate (DR) (DR of 78.6% with an false positive rate (FPR) of 1.2%) was obtained for a cutoff of 1/300 utilizing the "NT+T13" algorithm. The logistic regression model revealed that the central nervous system (CNS) anomalies had the greatest odds ratio (of 205.4) for T13. CONCLUSIONS The effectiveness of the multiparameter sonographic protocol used for T13 screening showed promising results in patients older than 36 years and suboptimal results in patients between 26 and 36 years old. When screening for T13 left heart defects, CNS anomalies, abdominal anomalies, FHR above the 95th percentile, increased NT, revDV and lack of NB should receive specific attention.
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Affiliation(s)
- Bartosz Rajs
- Department of Gynecology and Obstetrics, Jagiellonian University in Krakow, Krakow, Poland
| | | | - Anna Matyszkiewicz
- Department of Gynecology and Obstetrics, Jagiellonian University in Krakow, Krakow, Poland
- Ultrasound Group Practice "MWU DOBREUSG", Krakow, Poland
| | | | - Michał Kołodziejski
- Department of Gynecology and Obstetrics, Jagiellonian University in Krakow, Krakow, Poland
| | - Ewa Wiercińska
- Voivodship Sanitary-Epidemiological Station in Krakow, Krakow, Poland
| | - Marcin Wiecheć
- Department of Gynecology and Obstetrics, Jagiellonian University in Krakow, Krakow, Poland
- Ultrasound Group Practice "MWU DOBREUSG", Krakow, Poland
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Tekesin I. The diagnostic value of a detailed first trimester anomaly scan in fetuses with increased nuchal translucency thickness. J Perinat Med 2019; 47:241-246. [PMID: 30218607 DOI: 10.1515/jpm-2018-0145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/15/2018] [Indexed: 11/15/2022]
Abstract
Objectives To assess the diagnostic value of an early anomaly scan in fetuses with increased nuchal translucency (NT) in the prediction of aneuploidy. Methods In this study we analyzed the data of pregnant women obtained at their first trimester screening in our unit. The detailed examination routinely includes measurement of NT and a scan for anatomical defects. For fetuses with an NT≥3.5 mm, the diagnostic power of early major sonographic findings (MSF) regarding abnormal karyotype was calculated. Results A total of 7352 first trimester examinations were screened. Two hundred and twenty-two fetuses with an NT≥3.5 mm were analyzed. The median gestational age was 12.5 weeks (range 11.0-14.6) and the median NT was 5.1 mm (range 3.5-15.3). MSF were detected in 51.8% of fetuses with increased NT. Among 115 fetuses with MSF, 91 were aneuploid, yielding a positive predictive value for aneuploidy of 79.1%. In the absence of MSF, the negative predictive value was 70.1%. The presence of MSF was significantly predictive for aneuploidy both in bivariate and multivariate regression analysis. Conclusion Our study underlines the importance of a detailed anatomical ultrasound in fetuses with increased NT, as MSF occurred frequently. However, the diagnostic value of MSF regarding aneuploidies appears to be moderate.
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Affiliation(s)
- Ismail Tekesin
- Prenatal Unit Stuttgart, Alte Poststr. 3, D-70173 Stuttgart, Germany, Tel.: +497114006010, Fax: +4971140060120
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Wiechec M, Nocun A, Knafel A, Wiercinska E, Sonek J, Rozmus-Warcholinska W, Orzechowski M, Stettner D, Plevak P. Combined screening test for trisomy 21 - is it as efficient as we believe? J Perinat Med 2017; 45:185-191. [PMID: 27008689 DOI: 10.1515/jpm-2016-0031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 02/18/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To compare two first-trimester screening strategies: traditional combined screening and the one based on ultrasound markers only. We investigated the effect of maternal age (MA) on the screening performance of both of these strategies. METHODS This was a prospective observational study based on a non-selected mixed-risk population of 11,653 women referred for first-trimester screening. The study population was divided in two groups: combined screening (CS) and ultrasound-based screening (US). Absolute risk was calculated to determine the influence of MA on screening performance. RESULTS The CS arm comprised 5145 subjects including 51 cases of trisomy 21 (T21), and the US arm comprised 5733 subjects including 87 subjects with T21. Seven hundred and seventy-five subjects were excluded from the study. For a false positive rate (FPR) of 3%, the detection rate (DR) of T21 in CS arm was 78% vs. 90% in US arm. For 5% FPR, DR was 84% and 94% in CS and US arm, respectively. MA had an influence on DR positive rates in CS: both DR and FPR for T21 increased with advance in MA. CONCLUSIONS The US protocol showed higher DR of T21 compared to the CS one. It may be considered as a viable alternative to CS for T21 where access to biochemical testing is limited.
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Kaul A, Singh C, Gupta R, Arora N, Gupta A. Observational study comparing the performance of first-trimester screening protocols for detecting trisomy 21 in a North Indian population. Int J Gynaecol Obstet 2017; 137:14-19. [PMID: 28099747 DOI: 10.1002/ijgo.12087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/01/2016] [Accepted: 12/19/2016] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To evaluate first-trimester screening protocols for detecting trisomy 21 in an Indian population. METHODS The present prospective study collected data from women with singleton pregnancies and a crown-to-rump length of 45-84 mm who presented at the fetal medicine unit of a tertiary care center in North India between June 1, 2006, and December 31, 2015, for combined first-trimester screening. Maternal age, nuchal translucency, nasal bone, and maternal serum levels of free beta human chorionic gonadotropin and pregnancy-associated plasma protein A were assessed for calculating the risk of trisomy 21. Tricuspid regurgitation and qualitative analysis of ductus venosus data were available from June 2010, and were included where available. Trisomy-21 detection rates were calculated for various screening protocols and were compared. RESULTS There were 4523 women screened and 24 records of trisomy 21. Combined screening with maternal age, nuchal translucency, nasal bone, tricuspid regurgitation, and ductus venosus demonstrated optimal detection and false-positive rates of 93.8% and 1.9%, respectively. Screening using only maternal age yielded a detection rate of 37.5%; using fixed nuchal translucency cut-off values of 2.5 and 3 mm resulted in detection rates of 66.7% and 37.5%, respectively. CONCLUSION Combined first-trimester screening performed well in an Indian population; combining maternal age, nuchal translucency, nasal bone, ductus venosus, and tricuspid regurgitation yielded the most accurate screening.
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Affiliation(s)
- Anita Kaul
- Apollo Centre for Fetal Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | - Chanchal Singh
- Apollo Centre for Fetal Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | - Rachna Gupta
- Apollo Centre for Fetal Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | - Nidhi Arora
- Apollo Centre for Fetal Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | - Abha Gupta
- Department of Biochemistry, Indraprastha Apollo Hospitals, New Delhi, India
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Wiechec M, Knafel A, Nocun A, Ludwin A, Ludwin I, Maczka M, Zietek D, Pasternok M, Moosburger D, Zalewski S, Rozmus-Warcholinska W. Screening for trisomy 18 using traditional combined screening vs. ultrasound-based protocol in tertiary center environment. J Matern Fetal Neonatal Med 2016; 30:1765-1770. [PMID: 27597552 DOI: 10.1080/14767058.2016.1224837] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To compare the screening performances of combined screening test risk algorithm for trisomy 18 (T18) using various cutoffs with a multiparameter ultrasound-based method. To compare the general and maternal age (MA)-based screening performances for T18 by means of combined screening and an ultrasound-based method. METHODS This was a prospective, multicenter study based on a mixed-risk non-selected population of women referred to referral centers for a first-trimester screening. Each subject was offered a choice between either a traditional combined screening (CSG arm) or an ultrasound-based screening (USG arm). General and MA-based screening performances were measured. RESULTS The study population comprised 10 820 pregnancies as follows: 5132 in the CSG arm, including 28 cases of T18, and 5688 in the USG arm, including 29 cases of T18. In the CSG arm, the detection rate (DR) for T18 at a false-positive rate (FPR) of 3% was 86%, whereas the DR was 100% for the USG arm. MA influenced the T18 screening performance in the CSG arm and reduced the DR in MA ranges <26 years and 31-35 years. This influence was not observed in the USG arm. CONCLUSIONS Only, a multiparameter ultrasound-based screening method may be considered an effective alternative to combined screening for T18 screening. The technique exhibits high and stable DRs irrespective of MA.
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Affiliation(s)
- Marcin Wiechec
- a Department of Gynecology and Obstetrics , Jagiellonian University , Krakow , Poland.,b Ultrasound Group Practice "dobreusg," Krakow , Poland
| | - Anna Knafel
- b Ultrasound Group Practice "dobreusg," Krakow , Poland
| | | | - Artur Ludwin
- a Department of Gynecology and Obstetrics , Jagiellonian University , Krakow , Poland
| | - Inga Ludwin
- a Department of Gynecology and Obstetrics , Jagiellonian University , Krakow , Poland
| | - Marek Maczka
- c Center for Prenatal Diagnostics , Opole , Poland
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