Home Combined screening test for trisomy 21 – is it as efficient as we believe?
Article
Licensed
Unlicensed Requires Authentication

Combined screening test for trisomy 21 – is it as efficient as we believe?

  • Marcin Wiechec EMAIL logo , Agnieszka Nocun , Anna Knafel , Ewa Wiercinska , Jiri Sonek , Wioletta Rozmus-Warcholinska , Maciej Orzechowski , Dominika Stettner and Petr Plevak
Published/Copyright: March 23, 2016

Abstract

Objectives:

To compare two first-trimester screening strategies: traditional combined screening and the one based on ultrasound markers only. We investigated the effect of maternal age (MA) on the screening performance of both of these strategies.

Methods:

This was a prospective observational study based on a non-selected mixed-risk population of 11,653 women referred for first-trimester screening. The study population was divided in two groups: combined screening (CS) and ultrasound-based screening (US). Absolute risk was calculated to determine the influence of MA on screening performance.

Results:

The CS arm comprised 5145 subjects including 51 cases of trisomy 21 (T21), and the US arm comprised 5733 subjects including 87 subjects with T21. Seven hundred and seventy-five subjects were excluded from the study. For a false positive rate (FPR) of 3%, the detection rate (DR) of T21 in CS arm was 78% vs. 90% in US arm. For 5% FPR, DR was 84% and 94% in CS and US arm, respectively. MA had an influence on DR positive rates in CS: both DR and FPR for T21 increased with advance in MA.

Conclusions:

The US protocol showed higher DR of T21 compared to the CS one. It may be considered as a viable alternative to CS for T21 where access to biochemical testing is limited.


Corresponding author: Marcin Wiechec, Chair of Gynecology and Obstetrics, Jagiellonian University in Krakow, 23 Kopernik Street, 31-501 Krakow, Poland, Tel.: +48124248423, Fax: +48124248584; Ultrasound Group Practice “dobreusg”, 20A Felinskiego Street, 31-236 Krakow, Poland

Acknowledgments

We would like to acknowledge Anna Grzeszczak, MA, from Prof. Josef Tischner Complex of High Schools and Vocational Education in Limanowa, Poland, for her valuable input in language corrections of the original manuscript.

References

[1] Spencer K, Spencer CE, Power M, Dawson C, Nicolaides KH. Screening for chromosomal abnormalities in the first trimester using ultrasound and maternal serum biochemistry in a one-stop clinic: a review of three years prospective experience. Br J Obstet Gynaecol. 2003;110:281–6.10.1046/j.1471-0528.2003.02246.xSearch in Google Scholar

[2] Nicolaides KH, Spencer K, Avgidou K, Faiola S, Falcon O. Multicenter study of first trimester screening for trisomy 21 in 75821 pregnancies: results and estimation of the potential impact of individual risk-orientated two-stage first-trimester screening. Ultrasound Obstet Gynecol. 2005;25:221–6.10.1002/uog.1860Search in Google Scholar PubMed

[3] 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;31:618–24.10.1002/uog.5331Search in Google Scholar PubMed

[4] Wald NJ, Rodeck C, Hackshaw AK, Rudnicka A. SURUSS in perspective. Semin Perinatol 2005;29:225–35.10.1053/j.semperi.2005.05.006Search in Google Scholar PubMed

[5] Go AT, Hupkes HW, Lomecky M, Twisk J, Blankenstein JM, van Vugt JM. Evaluation of a programme for the prenatal screening for Down’s syndrome by ultrasonographic nuchal translucency measurement and serum determinations in the first trimester of pregnancy. Ned Tijdschr Geneeskd 2005;149:2795–9.Search in Google Scholar

[6] Engels MAJ, Heijboer AC, Blankenstein MA, Van Vugt JMG. Performance of first-trimester combined test for Down syndrome in different maternal age groups: reason for adjustments in screening policy? Prenat Diagn 2011;31:1241–5.10.1002/pd.2873Search in Google Scholar PubMed

[7] Gil MM, Quezada MS, Revello R, Akolekar R, Nicolaides KH. Analysis of cell-free DNA in maternal blood in screening for fetal aneuploidies: updated meta-analysis. Ultrasound Obstet Gynecol. 2015;45:249–66.10.1002/uog.14791Search in Google Scholar PubMed

[8] Everett TR, Chitty LS. Cell-free fetal DNA: the new tool in Fetal Medicine. Ultrasound Obstet Gynecol. 2015;45:499–507.10.1002/uog.14746Search in Google Scholar PubMed PubMed Central

[9] Zhang H, Gao Y, Jiang F, Fu M, Yuan Y, Guo Y, et al. Noninvasive prenatal testing for trisomy 21, 18 and 13-clinical experience from 146,958 pregnancies. Ultrasound Obstet Gynecol. 2015;45:530–8.10.1002/uog.14792Search in Google Scholar PubMed

[10] Nicolaides KH. Screening for fetal aneuploidies at 11 to 13 weeks. Prenat Diagn 2011;31:7–15.10.1002/pd.2637Search in Google Scholar PubMed

[11] Wiechec M, Knafel A, Nocun A, Matyszkiewicz A, Juszczak M, Wiercinska E, et al. How effective is first-trimester screening for Trisomy 21 based on Ultrasound only? Fetal Diagn Ther. 2016;39:105–12.10.1159/000434632Search in Google Scholar PubMed

[12] Abele H, Wagner P, Sonek J, Hoopmann M, Brucker S, Artunc-Ulkumen B, et al. First trimester ultrasound screening for Down syndrome based on maternal age, fetal nuchal translucency and different combinations of the additional markers nasal bone, tricuspid and ductus venosus flow. Prenat Diagn. 2015;35:1182–6.10.1002/pd.4664Search in Google Scholar PubMed

[13] Wapner R, Thom E, Simpson JL, Pergament E, Silver R, Filkins K, et al. First-trimester screening for trisomies 21 and 18. N Engl J Med. 2003;349:1405–13.10.1056/NEJMoa025273Search in Google Scholar PubMed

[14] Gebb J, Dar P. Should the first-trimester aneuploidy screen be maternal age adjusted? Screening by absolute risk versus risk adjusted to maternal age. Prenat Diagn. 2009;29:245–7.10.1002/pd.2157Search in Google Scholar PubMed

[15] Schmidt P, Hörmansdörfer C, Golatta M, Scharf A. Analysis of the distribution shift of detected aneuploidies by age independent first trimester screening. Arch Gynecol Obstet. 2010;281:393–9.10.1007/s00404-009-1137-6Search in Google Scholar PubMed

[16] Engels MA, Twisk JW, Blankenstein MA, van Vugt JM. Age independent first trimester screening for Down syndrome: improvement in test performance. Prenat Diagn. 2013;33:884–8.10.1002/pd.4153Search in Google Scholar PubMed

[17] Liao A, Sebire N, Geerts L, Cicero C, Nicolaides KH. Megacystis at 10–14 weeks of gestation: chromosomal defects and outcome according to bladder length. Ultrasound Obstet Gynecol. 2003;21:338–41.10.1002/uog.81Search in Google Scholar PubMed

[18] Kagan KO, Staboulidou I, Syngelaki A, Cruz J, Nicolaides KH. The 11–13-week scan diagnosis and outcome of holoprosencephaly, exomphalos and megacystis. Ultrasound Obstet Gynecol. 2010;36:10–4.10.1002/uog.7646Search in Google Scholar PubMed

[19] Tørring N, Petersen OB, Uldbjerg N. Ten years of experience with first-trimester screening for fetal aneuploidy employing biochemistry from gestational weeks 6+0 to 13+6. Fetal Diagn Ther. 2015;37:51–7.10.1159/000362665Search in Google Scholar PubMed

[20] Kotarski J, Wielgos M. Rekomendacje Polskiego Towarzystwa Ginekologicznego dotyczące postępowania w zakresie diagnostyki prenatalnej. Ginekol Pol 2009;80:390–3.Search in Google Scholar

[21] American Institute of Ultrasound in Medicine. AIUM practice guideline for the performance of obstetric ultrasound examinations. J Ultrasound Med. 2010;29:157–66.10.7863/jum.2010.29.1.157Search in Google Scholar PubMed

[22] Fetal Echocardiography Task Force; American Institute of Ultrasound in Medicine Clinical Standards Committee; American College of Obstetricians and Gynecologists; Society for Maternal-Fetal Medicine. AIUM practice guideline for the performance of fetal echocardiography. J Ultrasound Med. 2011;30:127–36.10.7863/jum.2011.30.1.127Search in Google Scholar PubMed

[23] Wald NJ, Rodeck C, Hackshaw AK, Walters J, Chitty L, Mackinson AM, et al. First and second trimester antenatal screening for Down’s syndrome: the results of the Serum, Urine and Ultrasound Screening Study (SURUSS). Health Technol Assess. 2003;7:1–77.10.3310/hta7110Search in Google Scholar PubMed

[24] Malone FD, Canick JA, Ball RH, Nyberg DA, Comstock CH, Bukowski R, et al. First-trimester or second-trimester screening, or both, for Down’s syndrome. N Engl J Med. 2005;353:2001–11.10.1056/NEJMoa043693Search in Google Scholar PubMed

[25] Lee FK, Chen LC, Cheong ML, Chou CY, Tsai MS. First trimester combined test for Down syndrome screening in unselected pregnancies-a report of a 13-year experience. Taiwan J Obstet Gynecol. 2013;52:523–6.10.1016/j.tjog.2013.10.012Search in Google Scholar PubMed

[26] Nicolaides, KH, Wright D, Poon LC, Syngelaki A, Gil MM. First-trimester contingent screening for trisomy 21 by biomarkers and maternal blood cell-free DNA testing. Ultrasound Obstet Gynecol. 2013;42;41–50.10.1002/uog.12511Search in Google Scholar PubMed

[27] Avgidou K, Papageorghiou A, Bindra R, Spencer K, Nicolaides KH. Prospective first-trimester screening for trisomy 21 in 30,564 pregnancies. Am J Obstet Gynecol. 2005;192:1761–7.10.1016/j.ajog.2005.03.021Search in Google Scholar PubMed

[28] Wapner RJ. First trimester screening: the BUN study. Semin Perinatol. 2005;29:236–9.10.1053/j.semperi.2005.05.013Search in Google Scholar PubMed

[29] Lau GW, Feldman DS, Morales CM, Smith D, Edwards R, Williams J 3rd. First-trimester aneuploidy screening: is there a maternal age at which it loses effectiveness? J Reprod Med. 2014;59:443–7.Search in Google Scholar

[30] Centini G, Rosignoli L, Scarinci R, Faldini E, Morra C, Centini G, Petraglia F. Re-evaluation of risk for Down syndrome by means of the combined test in pregnant women of 35 years or more. Prenat Diagn. 2005;25:133–6.10.1002/pd.1036Search in Google Scholar PubMed

[31] Nicolaides KH, Wright D, Poon LC, Syngelaki A, Gil MM. First-trimester contingent screening for trisomy 21 by biomarkers and maternal blood cell-free DNA testing. Ultrasound Obstet Gynecol. 2013;42;41–50.10.1002/uog.12511Search in Google Scholar

  1. The authors stated that there are no conflicts of interest regarding the publication of this article.

Received: 2015-9-25
Accepted: 2016-2-18
Published Online: 2016-3-23
Published in Print: 2017-2-1

©2017 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Fetal diagnosis and therapy: a continously evolving discipline
  4. Highlight articles
  5. Prenatally diagnosed fetal tumors of the head and neck: a systematic review with antenatal and postnatal outcomes over the past 20 years
  6. Prenatal screening for microcephaly: an update after three decades
  7. Fetal echocardiography: reference values for the Chinese population
  8. Multi-fetal pregnancy reduction (MFPR) to twins or singleton – medical justification and ethical slippery slope
  9. Combined screening test for trisomy 21 – is it as efficient as we believe?
  10. Fetal loss following invasive prenatal testing: a comparison of transabdominal chorionic villus sampling, transcervical chorionic villus sampling and amniocentesis
  11. Comparison of adverse perinatal outcomes after single-needle and double-needle CVS techniques
  12. Prenatal decision-making in the second and third trimester in trisomy 21-affected pregnancies
  13. Role of collagen type IV in the pathogenesis of increased prenasal thickness in Down syndrome fetuses: sonographic and immunohistological findings
  14. Congenital diaphragmatic hernia: endotracheal fluid phospholipidic profile following tracheal occlusion in an experimental model
  15. Original articles
  16. The effect of intraumbilical fetal nutrition via a subcutaneously implanted port system on amino acid concentration by severe IUGR human fetuses
  17. Anti-inflammatory Elafin in human fetal membranes
  18. Recombinant vascular endothelial growth factor 121 injection for the prevention of fetal growth restriction in a preeclampsia mouse model
  19. Estimation of fetal weight by ultrasonography after preterm premature rupture of membranes: comparison of different formulas
  20. Congress Calendar
  21. Congress Calendar
Downloaded on 28.9.2025 from https://www.degruyterbrill.com/document/doi/10.1515/jpm-2016-0031/html
Scroll to top button