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Mutation prediction models in Lynch syndrome: evaluation in a clinical genetic setting.
J Med Genet. 2009 Nov; 46(11):745-51.JM

Abstract

BACKGROUND/AIMS

The identification of Lynch syndrome is hampered by the absence of specific diagnostic features and underutilisation of genetic testing. Prediction models have therefore been developed, but they have not been validated for a clinical genetic setting. The aim of the present study was to evaluate the usefulness of currently available prediction models.

METHODS

The authors collected data of 321 index probands who were referred to the department of clinical genetics of the Erasmus Medical Center because of a family history of colorectal cancer. These data were used as input for five previously published models. External validity was assessed by discriminative ability (AUC: area under the receiver operating characteristic curve) and calibration. For further insight, predicted probabilities were categorised with cut-offs of 5%, 10%, 20% and 40%. Furthermore, costs of different testing strategies were related to the number of extra detected mutation carriers.

RESULTS

Of the 321 index probands, 66 harboured a germline mutation. All models discriminated well between high risk and low risk index probands (AUC 0.82-0.84). Calibration was well for the Premm(1,2) and Edinburgh model, but poor for the other models. Cut-offs could be found for the prediction models where costs could be saved while missing only few mutations.

CONCLUSIONS

The Edinburgh and Premm(1,2) model were the models with the best performance for an intermediate to high risk setting. These models may well be of use in clinical practice to select patients for further testing of mismatch repair gene mutations.

Authors+Show Affiliations

Department of Gastroenterology and Hepatology & Department of Public Health, Erasmus MC University Medical Center, 's Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands. d.ramsoekh@erasmusmc.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19541685

Citation

Ramsoekh, D, et al. "Mutation Prediction Models in Lynch Syndrome: Evaluation in a Clinical Genetic Setting." Journal of Medical Genetics, vol. 46, no. 11, 2009, pp. 745-51.
Ramsoekh D, van Leerdam ME, Wagner A, et al. Mutation prediction models in Lynch syndrome: evaluation in a clinical genetic setting. J Med Genet. 2009;46(11):745-51.
Ramsoekh, D., van Leerdam, M. E., Wagner, A., Kuipers, E. J., & Steyerberg, E. W. (2009). Mutation prediction models in Lynch syndrome: evaluation in a clinical genetic setting. Journal of Medical Genetics, 46(11), 745-51. https://doi.org/10.1136/jmg.2009.066589
Ramsoekh D, et al. Mutation Prediction Models in Lynch Syndrome: Evaluation in a Clinical Genetic Setting. J Med Genet. 2009;46(11):745-51. PubMed PMID: 19541685.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mutation prediction models in Lynch syndrome: evaluation in a clinical genetic setting. AU - Ramsoekh,D, AU - van Leerdam,M E, AU - Wagner,A, AU - Kuipers,E J, AU - Steyerberg,E W, Y1 - 2009/06/18/ PY - 2009/6/23/entrez PY - 2009/6/23/pubmed PY - 2010/2/13/medline SP - 745 EP - 51 JF - Journal of medical genetics JO - J Med Genet VL - 46 IS - 11 N2 - BACKGROUND/AIMS: The identification of Lynch syndrome is hampered by the absence of specific diagnostic features and underutilisation of genetic testing. Prediction models have therefore been developed, but they have not been validated for a clinical genetic setting. The aim of the present study was to evaluate the usefulness of currently available prediction models. METHODS: The authors collected data of 321 index probands who were referred to the department of clinical genetics of the Erasmus Medical Center because of a family history of colorectal cancer. These data were used as input for five previously published models. External validity was assessed by discriminative ability (AUC: area under the receiver operating characteristic curve) and calibration. For further insight, predicted probabilities were categorised with cut-offs of 5%, 10%, 20% and 40%. Furthermore, costs of different testing strategies were related to the number of extra detected mutation carriers. RESULTS: Of the 321 index probands, 66 harboured a germline mutation. All models discriminated well between high risk and low risk index probands (AUC 0.82-0.84). Calibration was well for the Premm(1,2) and Edinburgh model, but poor for the other models. Cut-offs could be found for the prediction models where costs could be saved while missing only few mutations. CONCLUSIONS: The Edinburgh and Premm(1,2) model were the models with the best performance for an intermediate to high risk setting. These models may well be of use in clinical practice to select patients for further testing of mismatch repair gene mutations. SN - 1468-6244 UR - https://www.unboundmedicine.com/medline/citation/19541685/Mutation_prediction_models_in_Lynch_syndrome:_evaluation_in_a_clinical_genetic_setting_ L2 - https://jmg.bmj.com/lookup/pmidlookup?view=long&pmid=19541685 DB - PRIME DP - Unbound Medicine ER -