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Clinical validation of a noninvasive prenatal test for genomewide detection of fetal copy number variants

American Journal of Obstetrics and Gynecology, Volume 215, Issue 2, August 2016, Pages 227.e1 - 227.e16

Background

Current cell-free DNA assessment of fetal chromosomes does not analyze and report on all chromosomes. Hence, a significant proportion of fetal chromosomal abnormalities are not detectable by current noninvasive methods. Here we report the clinical validation of a novel noninvasive prenatal test (NIPT) designed to detect genomewide gains and losses of chromosomal material ≥7 Mb and losses associated with specific deletions <7 Mb.

Objective

The objective of this study is to provide a clinical validation of the sensitivity and specificity of a novel NIPT for detection of genomewide abnormalities.

Study Design

This retrospective, blinded study included maternal plasma collected from 1222 study subjects with pregnancies at increased risk for fetal chromosomal abnormalities that were assessed for trisomy 21 (T21), trisomy 18 (T18), trisomy 13 (T13), sex chromosome aneuploidies (SCAs), fetal sex, genomewide copy number variants (CNVs) ≥7 Mb, and select deletions <7 Mb. Performance was assessed by comparing test results with findings from G-band karyotyping, microarray data, or high coverage sequencing.

Results

Clinical sensitivity within this study was determined to be 100% for T21 (95% confidence interval [CI], 94.6–100%), T18 (95% CI, 84.4–100%), T13 (95% CI, 74.7–100%), and SCAs (95% CI, 84–100%), and 97.7% for genomewide CNVs (95% CI, 86.2–99.9%). Clinical specificity within this study was determined to be 100% for T21 (95% CI, 99.6–100%), T18 (95% CI, 99.6–100%), and T13 (95% CI, 99.6–100%), and 99.9% for SCAs and CNVs (95% CI, 99.4–100% for both). Fetal sex classification had an accuracy of 99.6% (95% CI, 98.9–99.8%).

Conclusion

This study has demonstrated that genomewide NIPT for fetal chromosomal abnormalities can provide high resolution, sensitive, and specific detection of a wide range of subchromosomal and whole chromosomal abnormalities that were previously only detectable by invasive karyotype analysis. In some instances, this NIPT also provided additional clarification about the origin of genetic material that had not been identified by invasive karyotype analysis.

Key words: cell-free DNA, chromosomal copy number variant, genomewide, microdeletions, noninvasive prenatal testing, subchromosomal copy number variant.

Footnotes

a Sequenom Laboratories, San Diego, CA

b Sequenom Inc, San Diego, CA

Corresponding author: Mathias Ehrich, MD.

This study was funded by Sequenom Inc.

Authors are or were employed at and own stock or stock options in Sequenom Inc.

Cite this article as: Lefkowitz RB, Tynan JA, Liu T, et al. Clinical validation of a noninvasive prenatal test for genomewide detection of fetal copy number variants. Am J Obstet Gynecol 2016;215:227.e1-16.