Vail Paris J, Morris Brian, van Kan Aric, Burdett Brianna C, Moyes Kelsey, Theisen Aaron, Kerr Iain D, Wenstrup Richard J, Eggington Julie M
Myriad Genetic Laboratories, Inc., 320 Wakara Way, Salt Lake City, UT, 84108, USA.
J Community Genet. 2015 Oct;6(4):351-9. doi: 10.1007/s12687-015-0220-x. Epub 2015 Mar 18.
Genetic variants of uncertain clinical significance (VUSs) are a common outcome of clinical genetic testing. Locus-specific variant databases (LSDBs) have been established for numerous disease-associated genes as a research tool for the interpretation of genetic sequence variants to facilitate variant interpretation via aggregated data. If LSDBs are to be used for clinical practice, consistent and transparent criteria regarding the deposition and interpretation of variants are vital, as variant classifications are often used to make important and irreversible clinical decisions. In this study, we performed a retrospective analysis of 2017 consecutive BRCA1 and BRCA2 genetic variants identified from 24,650 consecutive patient samples referred to our laboratory to establish an unbiased dataset representative of the types of variants seen in the US patient population, submitted by clinicians and researchers for BRCA1 and BRCA2 testing. We compared the clinical classifications of these variants among five publicly accessible BRCA1 and BRCA2 variant databases: BIC, ClinVar, HGMD (paid version), LOVD, and the UMD databases. Our results show substantial disparity of variant classifications among publicly accessible databases. Furthermore, it appears that discrepant classifications are not the result of a single outlier but widespread disagreement among databases. This study also shows that databases sometimes favor a clinical classification when current best practice guidelines (ACMG/AMP/CAP) would suggest an uncertain classification. Although LSDBs have been well established for research applications, our results suggest several challenges preclude their wider use in clinical practice.
临床意义未明的基因变异(VUSs)是临床基因检测的常见结果。针对众多疾病相关基因已建立了位点特异性变异数据库(LSDBs),作为解释基因序列变异的研究工具,通过汇总数据促进变异解读。如果要将LSDBs用于临床实践,关于变异的存入和解读的一致且透明的标准至关重要,因为变异分类常被用于做出重要且不可逆转的临床决策。在本研究中,我们对从转诊至我们实验室的24,650例连续患者样本中鉴定出的2017个连续的BRCA1和BRCA2基因变异进行了回顾性分析,以建立一个无偏数据集,该数据集代表了美国患者群体中所见的变异类型,由临床医生和研究人员提交用于BRCA1和BRCA2检测。我们比较了五个可公开访问的BRCA1和BRCA2变异数据库(BIC、ClinVar、HGMD(付费版)、LOVD和UMD数据库)中这些变异的临床分类。我们的结果显示,可公开访问的数据库之间变异分类存在很大差异。此外,差异分类似乎不是单个异常值的结果,而是数据库之间广泛存在的分歧。这项研究还表明,当当前最佳实践指南(ACMG/AMP/CAP)建议不确定分类时,数据库有时会倾向于一种临床分类。尽管LSDBs已在研究应用中得到很好的确立,但我们的结果表明,一些挑战阻碍了它们在临床实践中的更广泛应用。