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临床外显子组测序报告:当前信息学实践与未来机遇

Clinical exome sequencing reports: current informatics practice and future opportunities.

作者信息

Swaminathan Rajeswari, Huang Yungui, Astbury Caroline, Fitzgerald-Butt Sara, Miller Katherine, Cole Justin, Bartlett Christopher, Lin Simon

机构信息

Research Information Solutions and Innovation, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.

Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital.

出版信息

J Am Med Inform Assoc. 2017 Nov 1;24(6):1184-1191. doi: 10.1093/jamia/ocx048.

Abstract

The increased adoption of clinical whole exome sequencing (WES) has improved the diagnostic yield for patients with complex genetic conditions. However, the informatics practice for handling information contained in whole exome reports is still in its infancy, as evidenced by the lack of a common vocabulary within clinical sequencing reports generated across genetic laboratories. Genetic testing results are mostly transmitted using portable document format, which can make secondary analysis and data extraction challenging. This paper reviews a sample of clinical exome reports generated by Clinical Laboratory Improvement Amendments-certified genetic testing laboratories at tertiary-care facilities to assess and identify common data elements. Like structured radiology reports, which enable faster information retrieval and reuse, structuring genetic information within clinical WES reports would help facilitate integration of genetic information into electronic health records and enable retrospective research on the clinical utility of WES. We identify elements listed as mandatory according to practice guidelines but are currently missing from some of the clinical reports, which might help to organize the data when stored within structured databases. We also highlight elements, such as patient consent, that, although they do not appear within any of the current reports, may help in interpreting some of the information within the reports. Integrating genetic and clinical information would assist the adoption of personalized medicine for improved patient care and outcomes.

摘要

临床全外显子组测序(WES)应用的增加提高了患有复杂遗传疾病患者的诊断率。然而,处理全外显子组报告中所含信息的信息学实践仍处于起步阶段,这一点从各基因实验室生成的临床测序报告中缺乏通用词汇就可以看出。基因检测结果大多以便携式文档格式传输,这可能会给二次分析和数据提取带来挑战。本文回顾了由三级医疗设施中经临床实验室改进修正案认证的基因检测实验室生成的临床外显子组报告样本,以评估和识别常见数据元素。与能够实现更快信息检索和再利用的结构化放射学报告一样,在临床WES报告中构建基因信息将有助于促进基因信息整合到电子健康记录中,并能够对WES的临床效用进行回顾性研究。我们识别出根据实践指南列为必填项但目前在一些临床报告中缺失的元素,这些元素在存储于结构化数据库时可能有助于组织数据。我们还强调了一些元素,如患者同意书,尽管它们未出现在当前任何报告中,但可能有助于解读报告中的一些信息。整合基因和临床信息将有助于采用个性化医疗,以改善患者护理和治疗结果。

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