Objectives: To evaluate the failure rate and performance of cell-free DNA (cfDNA) testing, mainly in terms of detection rates for trisomy 21, performed by 2 laboratories using different analytical methods. Methods: cfDNA testing was performed on 2,870 pregnancies with the HarmonyTM Prenatal Test using the targeted digital analysis of selected regions (DANSR) method, and on 2,635 pregnancies with the “Cerba test” using the genome-wide massively parallel sequencing (GW-MPS) method, with available outcomes. Propensity score analysis was used to match patients between the 2 groups. A comparison of the detection rates for trisomy 21 between the 2 laboratories was made. Results: In all, 2,811 patients in the Harmony group and 2,530 patients in the Cerba group had no trisomy 21, 18, or 13. Postmatched comparisons of the patient characteristics indicated a higher no-result rate in the Harmony group (1.30%) than in the Cerba group (0.75%; p = 0.039). All 41 cases of trisomy 21 in the Harmony group and 93 cases in the Cerba group were detected. Conclusions: Both methods of cfDNA testing showed low no-result rates and a comparable performance in detecting trisomy 21; yet GW-MPS had a slightly lower no-result rate than the DANSR method.

1.
Kagan KO, Wright D, Baker A, Sahota D, Nicolaides KH: Screening for trisomy 21 by maternal age, fetal nuchal translucency thickness, free beta-human chorionic gonadotropin and pregnancy-associated plasma protein-A. Ultrasound Obstet Gynecol 2008; 31: 618–624.
2.
Kagan KO, Wright D, Valencia C, Maiz N, Nicolaides KH: Screening for trisomies 21, 18 and 13 by maternal age, fetal nuchal trans­lucency, fetal heart rate, free beta-hCG and pregnancy-associated plasma protein-A. Hum Reprod 2008; 23: 1968–1975.
3.
Lo YM, Corbetta N, Chamberlain PF, Rai V, Sargent IL, Redman CW, Wainscoat JS: Presence of fetal DNA in maternal plasma and serum. Lancet 1997; 350: 485–487.
4.
Gil MM, Accurti V, Santacruz B, Plana MN, Nicolaides KH: Analysis of cell-free DNA in maternal blood in screening for aneuploidies: updated meta-analysis. Ultrasound Obstet Gynecol 2017; 50: 302–314.
5.
Nicolaides KH, Syngelaki A, Ashoor G, Birdir C, Touzet G: Noninvasive prenatal testing for fetal trisomies in a routinely screened first-trimester population. Am J Obstet Gynecol 2012; 207: 374.e1–e6.
6.
Song Y, Liu C, Qi H, Zhang Y, Bian X, Liu J: Noninvasive prenatal testing of fetal aneuploidies by massively parallel sequencing in a prospective Chinese population. Prenat Diagn 2013; 33: 700–706.
7.
Bianchi DW, Parker RL, Wentworth J, Madankumar R, Saffer C, Das AF, Craig JA, Chudova DI, Devers PL, Jones KW, Oliver K, Rava RP, Sehnert AJ; CARE Study Group: DNA sequencing versus standard prenatal aneuploidy screening. N Engl J Med 2014; 370: 799–808.
8.
Quezada MS, Gil MM, Francisco C, Oròsz G, Nicolaides KH: Screening for trisomies 21, 18 and 13 by cell-free DNA analysis of maternal blood at 10–11 weeks’ gestation and the combined test at 11–13 weeks. Ultrasound Obstet Gynecol 2015; 45: 36–41.
9.
Norton ME, Jacobsson B, Swamy GK, Laurent LC, Ranzini AC, Brar H, Tomlinson MW, Pereira L, Spitz JL, Hollemon D, Cuckle H, Musci TJ, Wapner RJ: Cell-free DNA analysis for noninvasive examination of trisomy. N Engl J Med 2015; 372: 1589–1597.
10.
Bevilacqua E, Ordóñez E, Hurtado I, Rueda L, Mazzone E, Cirigliano V, Jani JC: Screening for sex chromosome aneuploidy by cell-free DNA testing: patient choice and performance. Fetal Diagn Ther 2017, Epub ahead of print.
11.
Yaron Y, Jani J, Schmid M, Oepkes D: Current status of testing for microdeletion syndromes and rare autosomal trisomies using cell-free DNA technology. Obstet Gynecol 2015; 126: 1095–1099.
12.
Jani J, Rego de Sousa MJ, Benachi A: Cell-free DNA testing: how to choose which laboratory to use? Ultrasound Obstet Gynecol 2015; 46: 515–517.
13.
Takoudes T, Hamar B: Performance of non-invasive prenatal testing when fetal cell-free DNA is absent. Ultrasound Obstet Gynecol 2015; 45: 112.
14.
Bevilacqua E, Guizani M, Cos Sanchez T, Jani JC: Concerns with performance of screening for aneuploidy by cell-free DNA analysis of maternal blood in twin pregnancy. Ultrasound Obstet Gynecol 2016; 47: 124–125.
15.
Gil MM, Quezada MS, Revello R, Akolekar R, Nicolaides KH: Analysis of cell-free DNA in maternal blood in screening for aneuploidies: updated meta-analysis. Ultrasound Obstet Gynecol 2015; 45: 249–266.
16.
Bevilacqua E, Gil MM, Nicolaides KH, Ordoñez E, Cirigliano V, Dierickx H, Willems PJ, Jani JC: Performance of screening for aneuploidies by cell-free DNA analysis of maternal blood in twin pregnancies. Ultrasound Obstet Gynecol 2015; 45: 61–66.
17.
Gratacos E, Nicolaides K: Clinical perspective of cell-free DNA for fetal aneuploidies. Fetal Diagn Ther 2014; 35: 151–155.
18.
Zimmermann B, Hill M, Gemelos G, Demko Z, Banjevic M, Baner J, Ryan A, Sigurjonsson S, Chopra N, Dodd M, Levy B, Rabinowitz M: Noninvasive prenatal aneuploidy testing of chromosomes 13, 18, 21, X, and Y, using targeted sequencing of polymorphic loci. Prenat Diagn 2012; 32: 1233–1241.
19.
Sparks AB, Wang ET, Struble CA, Barrett W, Stokowski R, McBride C, Zahn J, Lee K, Shen N, Doshi J, Sun M, Garrison J, Sandler J, Hollemon D, Pattee P, Tomita-Mitchell A, Mitchell M, Stuelpnagel J, Song K, Oliphant A: Selective analysis of cell-free DNA in maternal blood for evaluation of fetal trisomy. Prenat Diagn 2012; 32: 3–9.
20.
Sparks AB, Struble CA, Wang ET, Song K, Oliphant A: Noninvasive prenatal detection and selective analysis of cell-free DNA obtained from maternal blood: evaluation for trisomy 21 and trisomy 18. Am J Obstet Gynecol 2012; 206: 319.e1–e9.
21.
Benachi A, Letourneau A, Kleinfinger P, Se­nat MV, Gautier E, Favre R, Bidat L, Houfflin-Debarge V, Bouyer J, Costa JM; Collaborative SEquençage a Haut Debit et Aneuploidies (SEHDA) Study Group: Cell-free DNA analysis in maternal plasma in cases of fetal abnormalities detected on ultrasound examination. Obstet Gynecol 2015; 125: 1330–1337.
22.
Jensen TJ, Zwiefelhofer T, Tim RC, Džakula Ž, Kim SK, Mazloom AR, Zhu Z, Tynan J, Lu T, McLennan G, Palomaki GE, Canick JA, Oeth P, Deciu C, van den Boom D, Ehrich M: High-throughput massively parallel sequencing for fetal aneuploidy detection from maternal plasma. PLoS One 2013; 8:e57381.
23.
Imai K, Ratkovic M: Robust estimation of inverse probability weights for marginal structural models. J Am Stat Assoc 2014; 110: 1013–1023.
24.
Austin PC: An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res 2011; 46: 399–424.
25.
Funk MJ, Westreich D, Wiesen C, Stürmer T, Brookhart MA, Davidian M: Doubly robust estimation of causal effects. Am J Epidemiol 2011; 173: 761–767.
26.
Kinnings SL, Geis JA, Almasri E, Wang H, Guan X, McCullough RM, Bombard AT, Saldivar JS, Oeth P, Deciu C: Factors affecting levels of circulating cell-free fetal DNA in maternal plasma and their implications for noninvasive prenatal testing. Prenat Diagn 2015; 35: 816–822.
27.
Le Conte G, Letourneau A, Jani J, Kleinfinger P, Lohmann L, Costa JM, Benachi A: Cell-free fetal DNA analysis in maternal plasma as a screening test for trisomy 21, 18 and 13 in twin pregnancies. Ultrasound Obstet Gynecol 2017, Epub ahead of print.
28.
Costa JM, Letourneau A, Favre R, Bidat L, Belaisch-Allart J, Jouannic JM, Quarello E, Senat MV, Broussin B, Tsatsaris V, Demain A, Kleinfinger P, Lohmann L, Agostini H, Bouyer J, Benachi A: Cell-free fetal DNA versus maternal serum screening for trisomy 21 in pregnant women with and without assisted reproduction technology: a prospective interventional study. Genet Med 2018, Epub ahead of print.
29.
Chen EZ, Chiu RW, Sun H, Akolekar R, Chan KC, Leung TY, Jiang P, Zheng YW, Lun FM, Chan LY, Jin Y, Go AT, Lau ET, To WW, Leung WC, Tang RY, Au-Yeung SK, Lam H, Kung YY, Zhang X, van Vugt JM, Minekawa R, Tang MH, Wang J, Oudejans CB, Lau TK, Nicolaides KH, Lo YM: Noninvasive prenatal diagnosis of fetal trisomy 18 and trisomy 13 by maternal plasma DNA sequencing. PLoS One 2011; 6:e21791.
30.
Porreco RP, Garite TJ, Maurel K, Marusiak B; Obstetrix Collaborative Research Network, Ehrich M, van den Boom D, Deciu C, Bombard A: Noninvasive prenatal screening for fetal trisomies 21, 18, 13 and the common sex chromosome aneuploidies from maternal blood using massively parallel genomic sequencing of DNA. Am J Obstet Gynecol 2014; 211: 365.e1–e12.
31.
Lun FM, Chiu RW, Chan KC, Leung TY, Lau TK, Lo YM: Microfluidics digital PCR reveals a higher than expected fraction of fetal DNA in maternal plasma. Clin Chem 2008; 54: 1664–1672.
32.
Chu T, Bunce K, Hogge WA, Peters DG: A novel approach toward the challenge of accurately quantifying fetal DNA in maternal plasma. Prenat Diagn 2010; 30: 1226–1229.
33.
Chan KC, Ding C, Gerovassili A, Yeung SW, Chiu RW, Leung TN, Lau TK, Chim SS, Chung GT, Nicolaides KH, Lo YM: Hypermethylated RASSF1A in maternal plasma: a universal fetal DNA marker that improves the reliability of noninvasive prenatal diagnosis. Clin Chem 2006; 52: 2211–2218.
34.
Nygren AO, Dean J, Jensen TJ, Kruse S, Kwong W, van den Boom D, Ehrich M: Quantification of fetal DNA by use of methylation-based DNA discrimination. Clin Chem 2010; 56: 1627–1635.
35.
Yu SC, Chan KC, Zheng YW, Jiang P, Liao GJ, Sun H, Akolekar R, Leung TY, Go AT, van Vugt JM, Minekawa R, Oudejans CB, Nicolaides KH, Chiu RW, Lo YM: Size-based molecular diagnostics using plasma DNA for noninvasive prenatal testing. Proc Natl Acad Sci USA 2014; 111: 8583–8588.
36.
Kim SK, Hannum G, Geis J, Tynan J, Hogg G, Zhao C, Jensen TJ, Mazloom AR, Oeth P, Ehrich M, van den Boom D, Deciu C: Determination of fetal DNA fraction from the plasma of pregnant women using sequence read counts. Prenat Diagn 2015; 35: 810–815.
37.
Crea F, Forman M, Hulme R, Old RW, Ryan D, Mazey R, Risley MD: The IONA® test: development of an automated cell-free DNA-based screening test for fetal trisomies 13, 18, and 21 that employs the ion proton semiconductor sequencing platform. Fetal Diagn Ther 2017; 42: 218–224.
38.
Cirigliano V, Ordoñez E, Rueda L, Syngelaki A, Nicolaides KH: Performance of the neoBona test: a new paired-end massively parallel shotgun sequencing approach for cell-free DNA-based aneuploidy screening. Ultrasound Obstet Gynecol 2017; 49: 460–464.
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