Brew Casey E, Castro Brian A, Pan Vivian, Hart Alexa, Blumberg Bruce, Wicklund Catherine
Division of Genetics, Birth Defects and Metabolism, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois.
Ambry Genetics, Aliso Viejo, California.
J Genet Couns. 2019 Apr;28(2):229-239. doi: 10.1002/jgc4.1112. Epub 2019 Mar 19.
Prenatal exome sequencing (ES) currently has limited use in the clinical setting, but research suggests that it has added diagnostic utility over karyotyping and array techniques for prenatal diagnosis of fetuses presenting with ultrasound abnormalities. The purpose of this study was to assess the attitudes of genetics professionals toward the clinical implementation of prenatal ES in order to guide development of professional guidelines. A survey was developed using themes identified in previous qualitative studies and was distributed to members of the American College of Medical Genetics and Genomics (ACMG), the American Society of Human Genetics (ASHG), and the National Society of Genetic Counselors (NSGC). A total of 498 participants completed some portion of the survey. There was consensus among participants that there would be clinical utility of prenatal ES when used for diagnosis, pregnancy management, and termination decisions. The majority also agreed that prenatal ES was distinct from its current use in the pediatric and adult settings. There were many areas of contention regarding which types of results should be returned to families and whether or not the current ACMG guidelines for return of incidental findings should also apply to the prenatal setting. Overall, professional guidance is needed to address the continuing concerns surrounding prenatal ES as its utilization in this setting is expected to grow.
目前,产前外显子组测序(ES)在临床环境中的应用有限,但研究表明,对于产前诊断超声异常的胎儿,它比核型分析和芯片技术具有更高的诊断效用。本研究的目的是评估遗传学专业人员对产前ES临床应用的态度,以指导专业指南的制定。利用先前定性研究中确定的主题设计了一项调查,并分发给美国医学遗传学与基因组学学会(ACMG)、美国人类遗传学学会(ASHG)和美国国家遗传咨询师协会(NSGC)的成员。共有498名参与者完成了部分调查。参与者们一致认为,产前ES用于诊断、妊娠管理和终止妊娠决策时具有临床效用。大多数人还同意,产前ES与目前在儿科和成人环境中的应用有所不同。在应向家庭反馈哪些类型的结果以及目前ACMG关于反馈偶发发现的指南是否也应适用于产前环境等方面,存在许多争议领域。总体而言,随着产前ES在该环境中的应用预计会增加,需要专业指导来解决围绕它的持续担忧。