Description and pilot results from a novel method for evaluating return of incidental findings from next-generation sequencing technologies.

Description and pilot results from a novel method for evaluating return of incidental findings from next-generation sequencing technologies.
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DOI:
10.1038/gim.2013.37
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发表时间:
2013-09
期刊:
Genetics in medicine : official journal of the American College of Medical Genetics
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开发、操作和试点测试一种透明、可重复和有证据的方法,以确定何时报告下一代测序技术的偶然发现。根据循证原则,我们提出了一个三阶段的过程。第一阶段“排除”低于最低证据阈值的偶然发现,并使用评分员间的一致性和与基于专家的方法的比较进行评估。第二阶段使用标准化方法记录临床可操作性标准,以允许专家一致地考虑并建议是否应定期报告结果(第三阶段)。我们使用专家意见,以确定表面效度的第二阶段和第三阶段使用三个案例研究。我们评估了第一阶段和第二阶段的时间和精力。对于第一阶段,我们评估了99种情况,发现评分者之间的一致性很高(89%),并且与单独的基于专家的方法高度一致。家族性腺瘤性息肉病、遗传性血色素沉着症和α1-抗胰蛋白酶缺乏症的病例研究都被推荐作为偶然发现进行常规报告。该方法每个主题需要不到三天的时间。我们建立了临床上可操作的偶然发现的操作定义,并提供了一个可行的方法,可扩展到整个基因组的文件和试点测试。
To develop, operationalize, and pilot test a transparent, reproducible, and evidence informed method to qualify when to report incidental findings from next generation sequencing technologies. Using evidence-based principles, we propose a three stage process. Stage I ‘rules out’ incidental findings below a minimal threshold of evidence and is evaluated using inter-rater agreement and comparison with an expert-based approach. Stage II documents criteria for clinical actionability using a standardized approach to allow experts to consistently consider and recommend whether results should be routinely reported (Stage III). We used expert opinion to determine the face validity of Stages II and III using three case studies. We evaluated the time and effort for Stages I and II. For Stage I, we assessed 99 conditions and found high inter-rater agreement (89%), and strong agreement with a separate expert-based method. Case studies for familial adenomatous polyposis, hereditary hemochromatosis, and α1-Antitrypsin Deficiency were all recommended for routine reporting as incidental findings. The method requires less than three days per topic. We establish an operational definition of clinically actionable incidental findings and provide documentation and pilot testing of a feasible method that is scalable to the whole genome.
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