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Comparison of risk calculation approaches in a screening programme for Down syndrome
Maria P H Koster1, Kirsten M Heetkamp, Esteriek de Miranda
1Laboratory for Infectious Diseases and Screening, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
Journal of Perinatal Medicine
|April 17, 2012
Summary
Harmonizing Down syndrome screening in the Netherlands improved risk calculation conformity between LifeCycle Elipse (LC) and Astraia software. This enhances the reliability of first-trimester screening for pregnant women.
Area of Science:
- Prenatal screening
- Maternal serum screening
- Fetal medicine
Background:
- Discrepancies in Down syndrome risk calculations exist between LifeCycle Elipse (LC) and Astraia software used in the Netherlands.
- This variability can lead to inconsistent risk assessments for pregnant women.
Purpose of the Study:
- To evaluate the conformity of Down syndrome risk calculations between LC and Astraia software before and after harmonization.
- To assess the influence of harmonization on first-trimester screening performance indicators.
Main Methods:
- Comparison of combined risks derived from biochemical markers (PAPP-A, fβ-hCG) and nuchal translucency measurements.
- Statistical analysis using intraclass correlation coefficient (ICC) and Cohen's kappa (κ).
- Evaluation of screening performance using area under the ROC curve and odds of being affected given a positive result (OAPR).
Main Results:
- High agreement between combined risks (ICC=0.99).
- Improved conformity after harmonization (Cohen's κ=0.75) compared to before (Cohen's κ=0.63).
- Similar screening performance for both software packages (Area under ROC curve=0.84), with LC slightly outperforming Astraia in OAPR before harmonization.
Conclusions:
- Harmonization significantly improved the conformity of Down syndrome risk calculations between the two software packages.
- While screening performance indicators were similar, harmonization is expected to further enhance agreement.
- Standardizing software is crucial for consistent prenatal screening outcomes.
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