Bao Yicheng K, Situ Betty A, Runner Margaret, Moshfeghi Andrew, Ameri Hossein
Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine, University of Southern California, 1450 San Pablo Street, Los Angeles, CA 90033, USA.
Retina Center of Texas, Dallas, TX 75243, USA.
J Clin Med. 2024 May 26;13(11):3118. doi: 10.3390/jcm13113118.
: Gene therapy's emergence has made molecular diagnosis for inherited retinal diseases clinically significant. Free genetic testing panels have improved testing access in clinical practice, yet the interpretation of results, especially variants of unknown significance (VUS), remains challenging and requires expertise. This study shares our experience in utilizing sponsored IRD panel tests by Invitae and Blueprint Genetics (BG), reporting their positivity rates, and comparing their reclassification of variants through amendments. : This retrospective study analyzed genetic test reports from patients who underwent testing via Invitae or BG panels. A positive test was determined if there was a pathogenic mutation in an autosomal dominant gene, two pathogenic mutations in an autosomal recessive gene, or a pathogenic mutation in an X-linked gene in a male patient. : The testing positivity rates were 34.9% for Invitae (n = 109) and 42.1% for BG (n = 107). Invitae had more pathogenic variants per report (0.87 vs. 0.58 variants, = 0.0038) and issued more amendments than BG (0.54 vs. 0.03 amendments; < 0.01). Of the Invitae variant classification changes, 66.2% switched a VUS to benign. In the BG group, 75% of variant reclassifications changed a VUS to pathogenic. As a result of the Invitae amendments, 88% did not change the overall report result. : While free-of-charge genetic testing panels offer valuable insights for diagnosing IRD, limitations such as low diagnostic yield and variant classification discrepancies persist between Invitae and BG. VUS should not be considered pathogenic in the clinical decision-making process. Careful interpretation of genetic testing is required.
基因治疗的出现使遗传性视网膜疾病的分子诊断在临床上具有重要意义。免费的基因检测套餐改善了临床实践中的检测可及性,但结果解读,尤其是意义未明变异(VUS)的解读,仍然具有挑战性且需要专业知识。本研究分享了我们使用Invitae和蓝图遗传学公司(BG)赞助的IRD套餐检测的经验,报告了它们的阳性率,并通过修正比较了它们对变异的重新分类情况。:这项回顾性研究分析了通过Invitae或BG套餐进行检测的患者的基因检测报告。如果常染色体显性基因存在致病突变、常染色体隐性基因存在两个致病突变或男性患者的X连锁基因存在致病突变,则检测结果判定为阳性。:Invitae的检测阳性率为34.9%(n = 109),BG的检测阳性率为42.1%(n = 107)。Invitae每份报告的致病变异更多(0.87个变异对0.58个变异, = 0.0038),且发出的修正比BG更多(0.54次修正对0.03次修正; < 0.01)。在Invitae的变异分类变化中,66.2%将一个VUS转变为良性。在BG组中,75%的变异重新分类将一个VUS转变为致病。由于Invitae的修正,88%没有改变总体报告结果。:虽然免费的基因检测套餐为IRD诊断提供了有价值的见解,但Invitae和BG之间仍存在低诊断率和变异分类差异等局限性。在临床决策过程中,VUS不应被视为致病。需要仔细解读基因检测结果。