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Clinical whole-exome sequencing: are we there yet?
Paldeep Singh Atwal1, Marie-Louise Brennan1, Rachel Cox1
1Division of Medical Genetics, Stanford University Medical Center, Stanford, California, USA.
Clinical whole-exome sequencing (WES) shows diagnostic value but faces challenges. Current success rates may be lower than reported, with issues in turnaround times, insurance coverage, and result interpretation impacting adoption.
Area of Science:
- Genomics
- Clinical Genetics
Background:
- Whole-exome sequencing (WES) became clinically available in 2011.
- Reported mutation detection rates vary widely (25-50%), but actual clinical success rates may be lower.
Purpose of the Study:
- To assess current causal gene detection rates in clinical whole-exome sequencing.
- To investigate insurance authorization issues and turnaround time accuracy.
- To gauge clinical geneticists' opinions on whole-exome sequencing.
Main Methods:
- Review of 35 clinical whole-exome sequencing reports.
- Electronic survey distributed to 47 clinical genetics centers.
Main Results:
- Observed a 22.8% success rate for causal gene detection, with one misidentified variant.
- Insurance coverage varied significantly among providers.
- Only 23.1% of reports met quoted turnaround times.
- Over 50% of surveyed clinicians had not ordered WES due to concerns.
Conclusions:
- Clinical whole-exome sequencing offers diagnostic utility.
- Clinician concerns persist regarding result interpretation, insurance coverage, and cost.
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