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Accuracy of non-invasive prenatal testing using cell-free DNA for detection of Down, Edwards and Patau syndromes : a systematic review and meta-analysis

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Taylor-Phillips, Sian, Freeman, Karoline, Geppert, Julia, Agbebiyi, Adeola, Uthman, Olalekan A., Madan, Jason, Clarke, Angus, Quenby, Siobhan and Clarke, Aileen (2016) Accuracy of non-invasive prenatal testing using cell-free DNA for detection of Down, Edwards and Patau syndromes : a systematic review and meta-analysis. BMJ Open, 6 (1). e010002. doi:10.1136/bmjopen-2015-010002

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Official URL: http://dx.doi.org/10.1136/bmjopen-2015-010002

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Abstract

Objective:

To measure test accuracy of non-invasive prenatal testing (NIPT) for Down, Edwards and Patau syndromes using cell-free fetal DNA and identify factors affecting accuracy.

Design:

Systematic review and meta-analysis of published studies.

Data sources:

PubMed, Ovid Medline, Ovid Embase and the Cochrane Library published from 1997 to 9 February 2015, followed by weekly autoalerts until 1 April 2015.

Eligibility:

Criteria for selecting studies English language journal articles describing case–control studies with ≥15 trisomy cases or cohort studies with ≥50 pregnant women who had been given NIPT and a reference standard.

Results:

41, 37 and 30 studies of 2012 publications retrieved were included in the review for Down, Edwards and Patau syndromes. Quality appraisal identified high risk of bias in included studies, funnel plots showed evidence of publication bias. Pooled sensitivity was 99.3% (95% CI 98.9% to 99.6%) for Down, 97.4% (95.8% to 98.4%) for Edwards, and 97.4% (86.1% to 99.6%) for Patau syndrome. The pooled specificity was 99.9% (99.9% to 100%) for all three trisomies. In 100 000 pregnancies in the general obstetric population we would expect 417, 89 and 40 cases of Downs, Edwards and Patau syndromes to be detected by NIPT, with 94, 154 and 42 false positive results. Sensitivity was lower in twin than singleton pregnancies, reduced by 9% for Down, 28% for Edwards and 22% for Patau syndrome. Pooled sensitivity was also lower in the first trimester of pregnancy, in studies in the general obstetric population, and in cohort studies with consecutive enrolment.

Conclusions:

NIPT using cell-free fetal DNA has very high sensitivity and specificity for Down syndrome, with slightly lower sensitivity for Edwards and Patau syndrome. However, it is not 100% accurate and should not be used as a final diagnosis for positive cases.

Item Type: Journal Article
Subjects: R Medicine > RC Internal medicine
R Medicine > RG Gynecology and obstetrics
Divisions: Faculty of Medicine > Warwick Medical School > Health Sciences
Faculty of Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET)
Faculty of Medicine > Warwick Medical School > Biomedical Sciences > Translational & Experimental Medicine > Reproductive Health ( - until July 2016)
Faculty of Medicine > Warwick Medical School > Biomedical Sciences > Translational & Experimental Medicine
Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH): Prenatal diagnosis, Fetu -- Diseases -- Diagnosis, Down syndrome, Trisomy
Journal or Publication Title: BMJ Open
Publisher: BMJ
ISSN: 2044-6055
Official Date: 18 January 2016
Dates:
DateEvent
18 January 2016Published
9 November 2015Accepted
15 September 2015Submitted
Volume: 6
Number: 1
Article Number: e010002
DOI: 10.1136/bmjopen-2015-010002
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Open Access
Funder: National Screening Committee, National Institute for Health Research (Great Britain) (NIHR), University Hospitals Birmingham NHS Foundation Trust
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