Abstract
BackgroundNoninvasive prenatal screening (NIPS) based on cell-free fetal DNA (cffDNA) has rapidly been applied into clinic. However, the reliability of this method largely depends on the concentration of cffDNA in the maternal plasma. The chance of test failure results or false negative results would increase when cffDNA fraction is low. In this study, we set out to develop a method to enrich the cffDNA for NIPS based on the size difference between cell-free DNA (cfDNA) of fetal origin and maternal origin, and to evaluate whether the new NIPS method can improve the test quality.MethodsWe utilized 10,000 previous NIPS data to optimize a size-selection strategy for enrichment. Then, we retrospectively performed our new NIPS method with cffDNA enrichment on the 1415 NIPS samples, including 1404 routine cases and 11 false negative cases, and compared the results to the original NIPS results.ResultsThe 10,000 NIPS data revealed the fetal fraction in short cfDNA fragments (< 160 bp) is significantly higher. By using our new NIPS strategy on the 1404 routine cases, the fetal fraction increased from 11.3 ± 4.2 to 22.6 ± 6.6%, and the new method performed a significant decrease of test-failure rate (0.1% vs 0.7%, P < 0.01). Moreover, in 45.5% (5/11) of the false negative cases, fetal trisomies were successfully detected by our new NIPS method.ConclusionsWe developed an effective method to enrich cffDNA for NIPS, which shows an increased success rate and a reduced chance of false negative comparing to the ordinary NIPS method.
Highlights
Noninvasive prenatal screening (NIPS) based on cell-free fetal DNA has rapidly been applied into clinic
Previous researches have shown that the extent of chromosomal abnormalities presented in plasma of women with aneuploidy pregnancies is linearly correlated with the cell-free fetal DNA (cffDNA) fraction, the test accuracy of NIPS largely relies on the fetal fraction [10]
Our results demonstrated the cffDNA enrichment strategy can improve the overall performance of NIPS by reducing false negative results as well as the test failure rate
Summary
Noninvasive prenatal screening (NIPS) based on cell-free fetal DNA (cffDNA) has rapidly been applied into clinic. The discovery of cell-free fetal DNA (cffDNA) in maternal plasma by Lo et al in 1997 has inspired various non-invasive prenatal screening (NIPS) applications [1], which avoids the ~ 1:100 chance for miscarriage. The reliability of NIPS largely depends on the assumption that there is sufficient fetal DNA in the samples tested [7]. Previous researches have shown that the extent of chromosomal abnormalities presented in plasma of women with aneuploidy pregnancies is linearly correlated with the cffDNA fraction, the test accuracy of NIPS largely relies on the fetal fraction [10]. NIPS misses about 1% chromosomal aneuploidy cases, and the most common factor associated with these false negative results is the low fetal fraction [11, 12]. As for the aforementioned reasons, it is critical to elevate fetal fraction for achieving convincing NIPS results
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