Practical considerations in the clinical application of whole-exome sequencing.

Journal Article (Journal Article)

Despite the exciting advent of whole-exome sequencing (WES) in medical genetics practices, the optimal interpretation of results requires further actions such as reconsidering clinical information and obtaining further laboratory testing. There are no published data to guide clinicians in this process. In a retrospective study on 93 patients who underwent clinical WES, we set out to assess and resolve these practical challenges. With the laboratories reporting a molecular diagnostic rate of 25.8%, the medical geneticists and the laboratories were 90% concordant in their interpretation of the WES results. Divergence occurred when the medical geneticist reconsidered clinical information and/or additional information regarding pathogenicity of a variant. Variants of uncertain significance were reported in 86% of patients, with 53.7% needing follow-up, such as additional laboratory tests and genotyping of family members. By layering clinical data (e.g. mode of inheritance and phenotypic fit) on to the laboratory results, we developed clinical categories for the WES results. These categories of definite diagnosis (14/93), likely diagnosis (8/93), possible diagnosis (13/93) and no diagnosis (58/93) could be used to convey results to patients uniformly. Our framework for a clinically informed interpretation of the results enhances the utility of WES within medical genetics practices.

Full Text

Duke Authors

Cited Authors

  • Shashi, V; McConkie-Rosell, A; Schoch, K; Kasturi, V; Rehder, C; Jiang, YH; Goldstein, DB; McDonald, MT

Published Date

  • February 2016

Published In

Volume / Issue

  • 89 / 2

Start / End Page

  • 173 - 181

PubMed ID

  • 25678066

Electronic International Standard Serial Number (EISSN)

  • 1399-0004

Digital Object Identifier (DOI)

  • 10.1111/cge.12569


  • eng

Conference Location

  • Denmark