Ann Lab Med 2019; 39(3): 299-310  https://doi.org/10.3343/alm.2019.39.3.299
Chromosomal Microarray Analysis as a First-Tier Clinical Diagnostic Test in Patients With Developmental Delay/Intellectual Disability, Autism Spectrum Disorders, and Multiple Congenital Anomalies: A Prospective Multicenter Study in Korea
Woori Jang, M.D.1,2, Yonggoo Kim, M.D.1,2, Eunhee Han, M.D.1,2, Joonhong Park, M.D.1,2, Hyojin Chae, M.D.1,2, Ahlm Kwon, M.T.2, Hayoung Choi, M.T.2, Jiyeon Kim, M.T.2, Jung-Ok Son, M.T.2, Sang-Jee Lee, M.D.3, Bo Young Hong, M.D.4, Dae-Hyun Jang, M.D.5, Ji Yoon Han, M.D.6, Jung Hyun Lee, M.D.7, So Young Kim, M.D.8, In Goo Lee, M.D.6, In Kyung Sung, M.D.6, Yeonsook Moon, M.D.9, Myungshin Kim , M.D.1,2, and Joo Hyun Park, M.D.10
1Department of Laboratory Medicine and 2Catholic Genetic Laboratory Center, College of Medicine, The Catholic University of Korea, Seoul, Korea; 3Department of Rehabilitation Medicine, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea; 4Department of Rehabilitation Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea; 5Department of Rehabilitation Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea; 6Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea; 7Department of Pediatrics, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea; 8Department of Pediatrics, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea; 9Department of Laboratory Medicine, Inha University School of Medicine, Incheon, Korea; 10Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
Corresponding author: Myungshin Kim, M.D. https://orcid.org/0000-0001-8632-0168
Department of Laboratory Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea
Tel: +82-2-2258-1645
Fax: +82-2-2258-1719
E-mail: microkim@catholic.ac.kr
Received: May 27, 2018; Revised: August 6, 2018; Accepted: November 7, 2018; Published online: May 1, 2019.
© Korean Society for Laboratory Medicine. All rights reserved.

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Abstract
Background: To validate the clinical application of chromosomal microarray analysis (CMA) as a first-tier clinical diagnostic test and to determine the impact of CMA results on patient clinical management, we conducted a multicenter prospective study in Korean patients diagnosed as having developmental delay/intellectual disability (DD/ID), autism spectrum disorders (ASD), and multiple congenital anomalies (MCA).
Methods: We performed both CMA and G-banding cytogenetics as the first-tier tests in 617 patients. To determine whether the CMA results directly influenced treatment recommendations, the referring clinicians were asked to complete a 39-item questionnaire for each patient separately after receiving the CMA results.
Results: A total of 122 patients (19.8%) had abnormal CMA results, with either pathogenic variants (N=65) or variants of possible significance (VPS, N=57). Thirty-five well-known diseases were detected: 16p11.2 microdeletion syndrome was the most common, followed by Prader–Willi syndrome, 15q11-q13 duplication, Down syndrome, and Duchenne muscular dystrophy. Variants of unknown significance (VUS) were discovered in 51 patients (8.3%). VUS of genes putatively associated with developmental disorders were found in five patients: IMMP2L deletion, PTCH1 duplication, and ATRNL1 deletion. CMA results influenced clinical management, such as imaging studies, specialist referral, and laboratory testing in 71.4% of patients overall, and in 86.0%, 83.3%, 75.0%, and 67.3% of patients with VPS, pathogenic variants, VUS, and benign variants, respectively.
Conclusions: Clinical application of CMA as a first-tier test improves diagnostic yields and the quality of clinical management in patients with DD/ID, ASD, and MCA.
Keywords: Chromosomal microarray analysis, Pathogenic, Variant of possible significance, Variant of unknown significance, Benign, Clinical management, Developmental delay, Intellectual disability, Autism spectrum disorders, Multiple congenital anomalies



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