Confusion over NIPT invites catastrophe

Timing is everything. A week after I wrote about false-positive NIPT results, the Boston Globe published an article titled "Oversold prenatal tests spur some to choose abortions" written by Beth Daley of the New England Center for Investigative Reporting. The article describes non-invasive prenatal testing (NIPT) using relatively new cell free DNA tests with a focus on women who have experienced receiving incorrect results.

The article focuses on one woman who had Sequenom's MaterniT21 PLUS test that indicated her fetus had trisomy 18 or Edwards syndrome. She initially considered immediately terminating the pregnancy and her doctor helped her locate a physician who could perform the procedure the next day. Only hours later did her doctor caution her to consider diagnostic testing which confirmed the fetus did not have trisomy 18. Additional cases in the article tell of one woman who experienced a false-positive result (confirmed by diagnostic testing) but so trusted the results of the DNA test that she aborted her pregnancy anyway and a woman who experience the trauma of a false-negative result.

Stories like this indicate a clear lack of understanding regarding the limitations of NIPT and demonstrate that physicians and consumers don't always appreciate the fact that these are screening tests. In a post on its blog about the Globe article, the Society for Maternal Fetal Medicine emphasizes just that by stating "It is important for providers to remember that cell free DNA is a screening test, and does not have the diagnostic accuracy of amniocentesis." They also point out that doctors who order DNA-based screening tests need to understand the test characteristics and they emphasize the role of genetic counseling for women who undergo screening for aneuploidy. The Society's statement was the focus of a follow-up piece by the New England Center for Investigative Reporting.

Whether aneuploidy screening is performed using DNA-based tests or by traditional biochemical screening, it is a screening test. Neither are diagnostic tests. Abnormal results from any screening test must be followed up by diagnostic testing to confirm (or not) the results of the screening test. To be misinformed on this basic fact of laboratory medicine is to flirt with disaster.

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