Vears Danya F, Sénécal Karine, Borry Pascal
Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
Leuven Institute for Human Genomics and Society, KU Leuven, Leuven, Belgium.
Hum Mutat. 2017 Aug;38(8):905-911. doi: 10.1002/humu.23259. Epub 2017 Jun 6.
While next-generation sequencing (NGS) has enormous potential to identify genetic causes of disease, the nature of the technology means that it can also identify additional information about the individual receiving sequencing that is unrelated to the original rationale for testing. Reporting these unsolicited findings (UF) to clinicians, and subsequently to patients, could lead to potentially lifesaving interventions. Most international guidelines provide limited specific recommendations as to whether these UF should be reported. Little research has been conducted exploring which of these variants are reported in practice. Twenty-six interviews were conducted with 27 laboratory personnel, representing 24 laboratories in Europe (12), Canada (five), and Australasia (Seven) to explore their reporting practices. There is considerable variation between laboratories in the reporting of UF. While some limit their reporting to findings that are relevant to the clinical question, others report UF to varying degrees. In addition, most laboratory personnel interviewed said that their laboratories do not actively search for secondary findings in disease-causing genes unrelated to the clinical question, such as those suggested by the American College of Medical Genetics and Genomics. Our study highlights that laboratories are still grappling with decisions about which UF to report from NGS and are calling for more guidance.
虽然下一代测序(NGS)在识别疾病的遗传病因方面具有巨大潜力,但该技术的性质意味着它也可能识别出与测序个体相关的、与检测的原始理由无关的额外信息。将这些意外发现(UF)报告给临床医生,进而报告给患者,可能会带来潜在的挽救生命的干预措施。大多数国际指南对于是否应报告这些意外发现提供的具体建议有限。关于在实际中报告哪些变异体的研究很少。我们对27名实验室人员进行了26次访谈,他们分别来自欧洲(12个)、加拿大(5个)和澳大拉西亚(7个)的24个实验室,以探讨他们的报告做法。在意外发现的报告方面,各实验室之间存在很大差异。一些实验室将报告限制在与临床问题相关的发现上,而另一些实验室则在不同程度上报告意外发现。此外,大多数接受采访的实验室人员表示,他们的实验室不会主动在与临床问题无关的致病基因中寻找次要发现,比如美国医学遗传学与基因组学学会所建议的那些基因。我们的研究强调,实验室仍在努力应对关于从NGS中报告哪些意外发现的决策,并呼吁提供更多指导。